AIMS: Transcatheter aortic valve replacement (TAVR) has become the standard of care for selected patients with severe aortic stenosis. Multidetector computed tomography (MDCT) and transoesophageal 2D/3D (two-dimensional/three-dimensional) echocardiography (ECHO) are used for aortic annulus (AA) sizing. The aim of this study was to compare the accuracy of AA sizing by ECHO versus MDCT for Edwards Sapien balloon expandable valve in a single center. METHODS AND RESULTS: Data from 145 consecutive patients with TAVR (Sapien XT or Sapien S3) were analyzed retrospectively. A total of 139 (96%) patients had favorable outcomes after TAVR (at most mild aortic regurgitation and only one valve implanted). The 3D ECHO AA area and area-derived diameter were smaller than the corresponding MDCT parameters (464 ± 99 vs. 479 ± 88 mm2 , p < .001, and 24.2 ± 2.7 vs. 25.0 ± 5.5 mm, p = .002, respectively). The 2D ECHO annulus measurement was smaller than both the MDCT and 3D ECHO area-derived diameters (22.6 ± 2.9 vs. 25.0 ± 5.5 mm, p = .013, and 22.6 ± 2.9 vs. 24.2 ± 2.7 mm, p < .001, respectively) but larger than the minor axis diameter of the AA derived from MDCT and 3D ECHO by multiplanar reconstruction (p < .001). The 3D ECHO circumference-derived diameter was also smaller than the MDCT circumference-derived diameter (24.3 ± 2.5 vs. 25.0 ± 2.3, p = .007). The sphericity index by 3D ECHO was smaller than that by MDCT (1.2 ± .1 vs. 1.3 ± .1, p < .001). In up to 1/3 of the patients, 3D ECHO measurements would have predicted different (generally smaller) valve size than was the valve size implanted with favorable result. The concordance of the implanted valve size with the recommended size based on preprocedural MDCT and 3D ECHO AA area was 79.4% versus 61% (p = .001), and for the area-derived diameter, the concordance was 80.1% versus 61.7% (p = .001). 2D ECHO diameter concordance was similar to MDCT (78.7%). CONCLUSIONS: 3D ECHO AA measurements are smaller than MDCT measurements. If 3D ECHO-based parameters alone are used to size the Edwards Sapien balloon expandable valve, then the selected valve size would have been smaller than the valve size implanted with favorable result in 1/3 of the patients. MDCT preprocedural TAVR assessment should be the preferred method over 3D ECHO in routine clinical practice to determine Edwards Sapien valve size.

Department of Cardioangiology University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Cardiology Mater Dei Hospital Triq Dun Karm L Imsida MSD 2090 and University of Malta Msida MSD Malta

Department of Cardiothoracic Surgery University Hospital Hradec Kralove Hradec Kralove Czech Republic

Department of Radiology University Hospital Hradec Kralove Hradec Kralove Czech Republic

Faculty of Medicine Hradec Kralove Charles University Prague Czech Republic

Institute of Biostatistics and Analyses Faculty of Medicine Masaryk University Brno Czech Republic

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Siontis GCM, Overtchouk P, Cahill TJ, et al. Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of symptomatic severe aortic stenosis: an updated meta-analysis. Eur Heart J. 2019;40:3143-3153. doi:10.1093/eurheartj/ehz275

Leon MB, Mack MJ, Hahn RT, et al. Outcomes 2 years after transcatheter aortic valve replacement in patients at low surgical risk. J Am Coll Cardiol. 2021;77:1149-1161. doi:10.1016/j.jacc.2020.12.052

Jilaihawi H, Doctor N, Kashif M, et al. Aortic annular sizing for transcatheter aortic valve replacement using cross-sectional 3-dimensional transoesophageal echocardiography. J Am Coll Cardiol. 2013;61:908-916. doi:10.1016/j.jacc.2012.11.055

Gripari P, Ewe SH, Fusini L, et al. Intraoperative 2D and 3D transoesophageal echocardiographic predictors of aortic regurgitation after transcatheter aortic valve implantation. Heart. 2012;16:1229-1236. doi:10.1136/heartjnl-2012-301998

Tang G, Lv O, He X. Comparison of postoperative outcomes following multidetector computed tomography based vs transesophageal echocardiography based annulus sizing for transcatheter aortic valve replacement: a systematic review and meta-analysis. Echocardiography. 2020;37:1617-1626. doi:10.1111/echo.14684

Wystub N, Bäz L, Möbius-Winkler S, et al. Aortic annulus measurement with computed tomography angiography reduces aortic regurgitation after transfemoral aortic valve replacement compared to 3-D echocardiography: a single-centre experience. Clin Res Cardiol. 2019;108:1266-1275. doi:10.1007/s00392-019-01462-6

Ninder RK, Webb JG, Willson A, et al. The impact of integration of a multidetector computed tomography annulus area sizing algorithm on outcomes of transcatheter aortic valve replacement: a prospective, multicenter, controlled trial. J Am Coll Cardiol. 2013;62(5):431-438. doi:10.1016/j.jacc.2013.04.036

Otto CM, Kumbhani DJ, Alexander KP, et al. 2017 ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American college of cardiology task force on clinical expert consensus documents. J Am Coll Cardiol. 2017;69:1313-1346. doi:10.1016/j.jacc.2016.12.006

Khalique OK, Hamid NB, White JM, et al. Impact of methodologic differences in three-dimensional echocardiographic measurements of the aortic annulus compared with computed tomographic angiography before transcatheter aortic valve replacement. J Am Soc Echocardiogr. 2017;30:414-421. doi:10.1016/j.echo.2016.10.012

Prihadi EA, van Rosendael PJ, Vollema EM, et al. Feasibility, accuracy, and reproducibility of aortic annular and root sizing for transcatheter aortic valve replacement using novel automated three-dimensional echocardiographic software: comparison with multi-detector row computed tomography. J Am Soc Ecocardiogr. 2018;31:505-514. doi:10.1016/j.echo.2017.10.003

Walther T, Dewey T, Borger M, et al. Transapical aortic valve implantation: step by step. Ann Thorac Surg. 2009;87:276-283. doi:10.1016/j.athoracsur.2008.08.017

Webb JG, Chandavimol M, Thompson CR, et al. Percutaneous aortic valve implantation retrograde from the femoral artery. Circulation. 2006;113:842-850. doi:10.1161/CIRCULATIONAHA.105.582882

Khalique OK, Hahn RT. 3D-TEE for measurement of the aortic annulus: a review of the literature and step-by-step approach to an essential skill. Curr Cardiovasc Imaging Rep. 2018;11:25.

Rong LQ, Hameed I, Salemi A, et al. Three-dimensional echocardiography for transcatheter aortic valve replacement sizing: a systematic review and meta-analysis. J Am Heart Assoc. 2019;8:e013463. doi:10.1161/JAHA.119.013463

Stella S, Italia L, Geremia G, et al. Accuracy and reproducibility of aortic annular measurements obtained from echocardiographic 3D manual and semi-automated software analyses in patients referred for transcatheter aortic valve implantation: implication for prosthesis size selection. Eur Heart J Cardiovasc Imaging. 2019;20:45-55. doi:10.1093/ehjci/jey013

Maia J, Ladeiras-Lopes R, Guerreiro C, et al. Accuracy of three-dimensional echocardiography in candidates for transcatheter aortic valve replacement. Int J Cardiovasc Imaging. 2020;36:291-298. doi:10.1007/s10554-019-01716-4

Podlesnikar T, Prihadi EA, van Rosendael PJ, et al. Influence of the quantity of aortic valve calcium on the agreement between automated 3-dimensional transesophageal echocardiography and multidetector row computed tomography for aortic annulus sizing. Am J Cardiol. 2018;121:86-93. doi:10.1016/j.amjcard.2017.09.016

Khalique OK, Kodali SK, Paradis JM, et al. Aortic annular sizing using a novel 3-dimensional echocardiographic method: use and comparison with cardiac computed tomography. Circ Cardiovasc Imaging. 2014;7:155-163. doi:10.1161/CIRCIMAGING.113.001153

Hahn RT, Khalique O, Williams MR, et al. Predicting paravalvular regurgitation following transcatheter valve replacement: utility of a novel method for three-dimensional echocardiographic measurements of the aortic annulus. J Am Soc Echocardiogr. 2013;26:1043-1052. doi:10.1016/j.echo.2013.07.004

Wang H, Hanna JM, Ganapathi A, et al. Comparison of aortic annulus size by transesophageal echocardiography and computed tomography angiography with direct surgical measurement. Am J Cardiol. 2015;115:1568-1573. doi:10.1016/j.amjcard.2015.02.060

Tsang W, Bateman MG, Weinert L, et al. Accuracy of aortic annular measurements obtained from three-dimensional echocardiography, CT and MRI: human in vitro and in vivo studies. Heart. 2012;98:1146e1152. doi:10.1136/heartjnl-2012-302074

Vaquerizo B, Spaziano M, Alali J, et al. Three-dimensional echocardiography vs. computed tomography for transcatheter aortic valve replacement sizing. Eur Heart J Cardiovas Imaging. 2016;17:15-23. doi:10.1093/ehjci/jev238

Binder RK, Webb JG, Willson AB, et al. The impact of integration of a multidetector computed tomography annulus area sizing algorithm on outcomes of transcatheter aortic valve replacement: a prospective, multicenter, controlled trial. J Am Coll Cardiol. 2013;62:431-438. doi:10.1016/j.jacc.2013.04.036

Medilek K, Bis J, Polansky P, Dusek J, Brtko M, Tuna M. Extrapolation of CT aortic annulus derived diamater/CT aortc annulus area from 2D echocardiography aortic annulus diamater in TAVR: not a reliable tool. Eur Heart J Cardiovasc Imaging. 2023;24:Suppl. 1. doi:10.1093/ehjci/jead119.137

Alskaf E, Kardos A. The mystery of defining aortic valve area: what have we learnt from three-dimensional imaging modalities? J Echocardiogr. 2018;16:130-138. doi:10.1007/s12574-018-0374-8

Heer LM, Budde RPJ, Malli WPTM, et al. Aortic root dimensions changes during systole and diastole: evaluation with E Imnt JCG gated multidetector row computed tomography. Int J Cardiovasc Imaging. 2011;27:1195-1204. doi:10.1007/s10554-011-9838-x

Tops LF, Wood DA, Delgado V, et al. Noninvasive evaluation of the aortic root with multislice computed tomography. J Am Coll Cardiol Cardiovasc Imaging. 2008;1:321-330. doi:10.1016/j.jcmg.2007.12.006

Hu X, Frellesen C, Bauer RW, et al. Computed tomography of dynamic changes of the aortic root during systole and diastole in patients with coronary artery calcification. Radiol Med. 2015;120:595-602. doi:10.1007/s11547-015-0503-7

Shabestari AA, Pourghorban R, Tehrai M, et al. Comparison of aortic root dimension changes during cardiac cycle between the patients with and without aortic valve calcification using ECG-gated 64-slice and dual-source 256-slice computed tomography scanners: results of a multicenter study. Int J Cardiovasc Imaging. 2013;29:1391-1400. doi:10.1007/s10554-013-0217-7