Comparative analysis of TAVI planning software: implications for prosthesis sizing and clinical outcome
A Claes, B P Paelinck, I E Rodrigus, T R Vandendriessche, T Jardinet, F De Roeck, J M Bosmans, P L Van HerckAbstract
Background
Multidetector computed tomography (MDCT) is the gold standard imaging modality for preprocedural planning of transcatheter aortic valve implantation (TAVI). Several dedicated software tools have been developed for morphometric aortic root assessment. However, comparative data on measurement agreement and reproducibility across platforms are limited, and the clinical relevance of software-related measurement discrepancies remains underexplored.
Purpose
The study aimed (1) to compare morphometric aortic root measurements obtained using three MDCT postprocessing tools; and (2) to evaluate the impact of measurement discrepancies on prosthesis sizing and clinical outcome following TAVI.
Methods
In 104 consecutive TAVI patients, aortic root dimensions essential for prosthesis sizing were measured using postprocessing software of GE Healthcare, 3mensio ValvesTM and FEops HEARTguideTM. Prosthesis sizing was performed according to the standardised Medtronic sizing matrix, and agreement in sizing across platforms was evaluated. Clinical outcomes were compared between patients with concordant (agreement across all three platforms) and discordant sizing recommendations (disagreement across ≥ 2 platforms).
Results
Compared with 3mensio ValvesTM, GE software yielded larger annulus perimeter measurements (mean difference: 0.8 mm and limits of agreement: [-2.1,3.8]) (Figure 1), whereas FEops HEARTguideTM yielded smaller measurements (mean difference: -0.6 mm and limits of agreement: [-4.9,3.6]). Importantly, measurement discrepancies resulted in discordant prosthesis sizing in up to 16% of cases (Figure 2). Sizing discordance was associated with a trend toward a higher incidence of new-onset left bundle branch block (26.0% versus 33.3%), particularly in cases where GE software recommended a larger prosthesis size compared with 3mensio ValvesTM and FEops HEARTguideTM.
Conclusion(s)
Differences in aortic root measurements exist among MDCT software tools for TAVI planning. These discrepancies translate into discordant prosthesis sizing in a substantial proportion of patients, particularly those with borderline annular dimensions, and may have implications for postprocedural clinical outcomes.Figure 1.Bland-Altman Plot Annulus PerimeterFigure 2.Distribution of Prosthesis Sizes