Marco Spaziano

Three-dimensional echocardiography vs. computed tomography for transcatheter aortic valve replacement sizing

AIMSnThe accuracy of transcatheter aortic valve replacement (TAVR) sizing using three-dimensional transoesophageal echocardiography (3D-TEE) compared with the gold-standard multi-slice computed tomography (MSCT) remains unclear. We compare aortic annulus measurements assessed using these two imaging modalities.nnnMETHODS AND RESULTSnWe performed a single-centre prospective cohort study, including 53 consecutive patients undergoing TAVR, who had both MSCT and 3D-TEE for aortic annulus sizing. Aortic annular dimensions, expected transcatheter heart valve (THV) oversizing, and hypothetical valve size selection based on CT and TEE were compared. 3D-TEE and CT cross-sectional mean diameter (r = 0.69), perimeter (r = 0.70), and area (r = 0.67) were moderately to highly correlated (all P-values <0.0001). 3D-TEE-derived measurements were significantly smaller compared with MSCT: perimeter (68.6 ± 5.9 vs. 75.1 ± 5.7 mm, respectively; P < 0.0001); area (345.6 ± 64.5 vs. 426.9 ± 68.9 mm(2), respectively; P < 0.0001). The percentage difference between 3D-TEE and MSCT measurements was around 9%. Agreement between MSCT- and 3D-TEE-based THV sizing (perimeter) occurred in 44% of patients. Using the 3D-TEE perimeter annular measurements, up to 50% of patients would have received an inappropriate valve size according to manufacturer-recommended, area-derived sizing algorithms.nnnCONCLUSIONnAortic annulus measurements for pre-procedural TAVR assessment by 3D-TEE are significantly smaller than MSCT. In this study, such discrepancy would have resulted in up to 50% of all patients receiving the wrong THV size. 3D-TEE should be used for TAVR sizing, only when MSCT is not available or contraindicated. The clinical impact of this information requires further study.

TCT-521 Novel non-invasive quantitative flow ratio for estimating fractional flow reserve

TCT-521 Novel non-invasive quantitative flow ratio for estimating fractional flow reserve Antoinette Neylon, Andrew Roy, Thomas Hovasse, Bernard Chevalier, Philippe Garot, Hakim Benamer, Yves Louvard, Leticia Fernandez-Lopez, Fadi Sawaya, Marco Spaziano, Yann Roux, Thierry Lefevre Institut Cardiovasculaire Paris Sud, Paris, France; ICPS, Paris, France; United States; Institut Cardiovasculaire Paris Sud, Massy, France; Institut Cardiovasculaire Paris SUD-Hopital Jacques Cartier, Massy, France; ICPS Massy, France, Massy, France; Institut Hospitalier Jacques Cartier, Massy, France; Institut Hospitalier Jacques Cartier, Paris, France; ICPS, Paris, France; McGill University Health Center, Montreal, Quebec, Canada; Clinque Pasteur, Toulouse, France; Institut Hospitalier Jacques Cartier, Massy, France

Treatment of Coronary Bifurcation Lesions

The optimal treatment for coronary bifurcation lesions is still the subject of debate. Balloon angioplasty for this type of lesion used to be associated with significant risk of acute complications compounded by a high risk of recurrent stenosis. With the advent of bare-metal stents, the first controversies arose as to whether one or several stents should be used to treat these lesions. The outcome of various nonrandomized studies demonstrated the benefit of implementing a single-stent strategy, whereby a stent is implanted in the main branch across the side branch. Drug-eluting stents allowed considerable reduction in the risk of restenosis and repeat interventions while encouraging the development of numerous complex techniques permitting complete bifurcation coverage. However, the results of large randomized studies, for which 5-year data is now available, confirmed the absence of benefits for complex strategies compared with provisional side-branch stenting, when both approaches are possible. Today, the provisional side branch stenting approach is considered the gold standard. This chapter explains when and how to perform this technique and how to resolve common difficulties. It also describes when and how to use a two-stent approach.

PROGNOSTIC IMPACT OF PRE AND POST-PROCEDURAL CARDIAC BIOMARKERS FOR TRANSCATHETER AORTIC VALVE IMPLANTATION

occlusion, two flow-limiting stenoses and three perforations of the common femoral artery. Five complications were successfully managed using self-expanding stents from the transradial access. The 3 cases of perforation (1.6%) were successfully treated with a covered stent delivered via femoral crossover. There were no additional major vascular complications at 30 days. CONCLUSION: Use of the radial approach for secondary access in TAVI is safe and feasible. Most primary access site complications were manageable from the radial access site. A low rate of crossover to the contralateral femoral approach (1.6 %) was necessary. Further large-scale studies are necessary to confirm the benefits of this approach.

TCT-742 Transcatheter aortic valve implantation in patients aged ≤75 years versus >75 years: a matched comparison

Creighton University, Honolulu, Hawaii, United States; University of California, Davis; San Francisco Vterans Affairs Medical Centetr, San Francisco, California, United States; St. Paul’s Hospital, Vancouver, British Columbia, Canada; University of British Columbia, Vancouver, British Columbia, Canada; University of California San Francisco, San Francisco, California, United States; San Francisco VAMC, San Francisco, California, United States

TCT-275 Management strategies for wire crossable undilatable CTO lesions

BACKGROUND The Stingray balloon and wire (Boston Scientific, Natick, MA) have been instrumental in improving true lumen re-entry when antegrade dissection (ADR) is used in chronic total occlusion (CTO) percutaneous coronary intervention (PCI). Current guidelines on the utilization of the device are based on expert operator opinion and experience without empiric data. We sought to characterize the utilization of Stingray assisted re-entry in a large contemporary registry of CTO PCI.

Left Ventricular Dilatation Assessed on the Lateral Chest Radiograph: The Classic Hoffman and Rigler Sign Falls Short in a Modern-Day Population

BACKGROUNDnThe classic Hoffman and Rigler (H&R) sign, originally described in 1965, suggests that left ventricular (LV) dilatation is present if the left ventricle extends more than 18 mm posterior to the inferior vena cava at a level 2 cm above their crossing on a lateral chest radiograph. This sign is still widely used by radiologists but has not been well evaluated against modern methods of noninvasive assessment. This study investigated the sensitivity and specificity of the H&R sign in a modern population.nnnMETHODSnA sample of 145 patients with LV dilatation based on current echocardiographic criteria was matched for age and sex with 145 patients without LV dilatation. Patients were required to have undergone a lateral chest radiograph in the 3 months before or after undergoing echocardiography; the H&R sign and the cardiothoracic index were assessed on the radiograph independently by 2 blinded physicians.nnnRESULTSnUsing the threshold value of 18 mm, sensitivity, specificity, and positive and negative likelihood ratios of the H&R sign were 54.9%, 59.2%, 1.34, and 0.76, respectively (area under the curve [AUC], 0.58). In comparison, the cardiothoracic index provided better prediction of LV dilatation (sensitivity, 87.9%; specificity, 47.5%; AUC, 0.72).nnnCONCLUSIONSnThe H&R sign is a poor marker of LV enlargement when compared with echocardiography and should not be used as a radiologic index of LV enlargement.