scholarly journals Feasibility of a High-Pitch Protocol for Transcatheter Aortic Valve Replacement Evaluation in Patients not Suitable for ECG-Gated CT

2020 ◽  
Author(s):  
Seyd Shnayien ◽  
Keno Bressem ◽  
Nick Beetz ◽  
Janis Vahldiek ◽  
Bernd Hamm ◽  
...  
Keyword(s):  
Image Quality ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Transcatheter Aortic Valve Replacement ◽  
The United States ◽  
Image Noise ◽  
High Pitch ◽  
Transcatheter Aortic Valve

Abstract High-Pitch CT for TAVR Evaluation in Patients not Suitable for ECG-GatingThe use of transcatheter aortic valve replacement (TAVR) has been established to be non-inferior to surgical aortic valve replacement (SAVR). As a result, in the United States, more patients now undergo TAVR than SAVR. It is recommended that preprocedural CT imaging for aortic valve evaluation and optimal sizing should include an ECG-gated scan of, at least, the aortic root. However, many patients suffer from concomitant tachyarrhythmias such as atrial fibrillation, which may seriously degrade the diagnostic accuracy of ECG-gated scans. The aim of the present study is to explore whether a high-pitch non-ECG-gated computed tomography angiography (CTA) of the entire aorta can render similar diagnostic preprocedural images as a standard ECG-gated scan. 108 patients were included. Objective image quality parameters such as image noise, CNR and SNR as well as subjective image quality analysis by two different readers were compared. The results showed a significant increase in image noise at the level of the aortic root with use of the high-pitch protocol (p = 0.001). Otherwise, our study revealed no significant differences in subjective and objective image quality. Diagnostic image quality was achieved in all patients without a record of inaccurate sizing in the surgical reports or subsequent patient histories.

Temporal Trends in Resource Use, Cost, and Outcomes of Transcatheter Aortic Valve Replacement in the United States

2020 ◽  
Vol 95 (12) ◽  
pp. 2665-2673
Author(s):  
Akram Kawsara ◽  
Samian Sulaiman ◽  
Jane Linderbaum ◽  
Sarah R. Coffey ◽  
Fahad Alqahtani ◽  
...  
Keyword(s):  
United States ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Resource Use ◽  
Transcatheter Aortic Valve Replacement ◽  
Temporal Trends ◽  
The United States ◽  
Transcatheter Aortic Valve

scholarly journals Socioeconomic and Geographic Characteristics of Hospitals Establishing Transcatheter Aortic Valve Replacement Programs, 2012–2018

2021 ◽  
Author(s):  
Ashwin S. Nathan ◽  
Lin Yang ◽  
Nancy Yang ◽  
Sameed Ahmed M. Khatana ◽  
Elias J. Dayoub ◽  
...  
Keyword(s):  
United States ◽  
Socioeconomic Status ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Metropolitan Areas ◽  
The United States ◽  
Medicare Beneficiaries ◽  
Transcatheter Aortic Valve

Background: Despite the benefits of novel therapeutics, inequitable diffusion of new technologies may generate disparities. We examined the growth of transcatheter aortic valve replacement (TAVR) in the United States to understand the characteristics of hospitals that developed TAVR programs and the socioeconomic status of patients these hospitals served. Methods: We identified fee-for-service Medicare beneficiaries aged 66 years or older who underwent TAVR between January 1, 2012, and December 31, 2018, and hospitals that developed TAVR programs (defined as performing ≥10 TAVRs over the study period). We used linear regression models to compare socioeconomic characteristics of patients treated at hospitals that did and did not establish TAVR programs and described the association between core-based statistical area level markers of socioeconomic status and TAVR rates. Results: Between 2012 and 2018, 583 hospitals developed new TAVR programs, including 572 (98.1%) in metropolitan areas, and 293 (50.3%) in metropolitan areas with preexisting TAVR programs. Compared with hospitals that did not start TAVR programs, hospitals that did start TAVR programs treated fewer patients with dual eligibility for Medicaid (difference of −2.83% [95% CI, −3.78% to −1.89%], P ≤0.01), higher median household incomes (difference $2447 [95% CI, $1348–$3547], P =0.03), and from areas with lower distressed communities index scores (difference −4.02 units [95% CI, −5.43 to −2.61], P ≤0.01). After adjusting for the age, clinical comorbidities, race and ethnicity and socioeconomic status, areas with TAVR programs had higher rates of TAVR and TAVR rates per 100 000 Medicare beneficiaries were higher in core-based statistical areas with fewer dual eligible patients, higher median income, and lower distressed communities index scores. Conclusions: During the initial growth phase of TAVR programs in the United States, hospitals serving wealthier patients were more likely to start programs. This pattern of growth has led to inequities in the dispersion of TAVR, with lower rates in poorer communities.

scholarly journals Effect of Eccentric Calcification of an Aortic Valve on the Implant Depth of a Venus-A Prosthesis During Transcatheter Aortic Valve Replacement: A Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Lanlan Li ◽  
Yang Liu ◽  
Ping Jin ◽  
Jiayou Tang ◽  
Linhe Lu ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Transcatheter Aortic Valve Replacement ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Release Process ◽  
Standard Position ◽  
Transcatheter Aortic Valve

ObjectOur goal was to assess the implant depth of a Venus-A prosthesis during transcatheter aortic valve replacement (TAVR) when the areas of eccentric calcification were distributed in different sections of the aortic valve.MethodsA total of 53 patients with eccentric calcification of the aortic valve who underwent TAVR with a Venus-A prosthesis from January 2018 to November 2019 were retrospectively analyzed. The patients were divided into three groups (A, B, and C) according to the location of the eccentric calcification, which was determined by preprocedural computerized tomography angiography (CTA) images. The prosthesis release process and position were evaluated by contrast aortography during TAVR, and the differences in valve implant depths were compared among the three groups. The effects of different aortic root structures and procedural strategies on prosthesis implant depth were analyzed.ResultsEleven patients had eccentric calcification in region A; 19 patients, in region B; and 23 patients, in region C. The patients with eccentric calcification in region B had a higher risk of prosthesis migration (10.5% upward and 21.1% downward), and the position of the prosthesis after TAVR in group B was the deepest among the three groups. When eccentric calcification was located in region A or C, the prosthesis was released at the standard position with more stability, and the location of the prosthesis was less deep after TAVR (region A: 4.12 ± 3.4 mm; region B: 10.2 ± 5.3 mm; region C: 8.4 ± 4.0 mm; region A vs. region B, P = 0.0004; region C vs. region B; and P = 0.0360). In addition, the left ventricular outflow tract (LVOT) (P = 0.0213) and aortic root angulation (P = 0.0263) also had a significant effect on implant depth in the aortic root structure of the patients. The prosthesis size was 28.3 ± 2.4 in the deep implant group and 26.4 ± 2.0 in the appropriate implant group (P = 0.0068).ConclusionThe implant depth of the Venus-A prosthesis is closely related to the distribution of eccentric calcification in the aortic valve during TAVR. Surgeons should adjust the surgical strategy according to aortic root morphology to prevent prosthesis migration.

Economic Considerations in Access to Transcatheter Aortic Valve Replacement

2022 ◽  
Author(s):  
Kriyana P. Reddy ◽  
Peter W. Groeneveld ◽  
Jay Giri ◽  
Alexander C. Fanaroff ◽  
Ashwin S. Nathan
Keyword(s):  
United States ◽  
Aortic Valve ◽  
Aortic Stenosis ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
The United States ◽  
Socioeconomically Disadvantaged ◽  
Transcatheter Aortic Valve ◽  
Economic Considerations

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of aortic stenosis, with the number of procedures and sites offering the procedure steadily rising over the past decade in the United States. Despite this, growth into certain markets has been limited as hospitals have to balance high TAVR costs with the ability to offer a complete array of state-of-the-art therapies for aortic stenosis. This trade-off often results in decreased access to TAVR services by patients cared for in hospitals that cannot afford these services or have difficulty meeting procedural requirements, recruiting skilled physicians, and initiating and then maintaining a functioning TAVR program. The lack of access is more common among patients of color or those who are socioeconomically disadvantaged. The purpose of this review is to describe the hospital-level economic considerations of TAVR in the United States and the resulting effects on geographic, racial, ethnic, and socioeconomic access for Americans.

Abstract 17600: Improved Iterative Reconstruction Reduces Artifacts and Results in Larger Measurements of Ileofemoral Artery Size on Computed Tomography in Patients Referred for Transcatheter Aortic Valve Replacement

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Anum Minhas ◽  
Smita Patel ◽  
Ella Kazerooni ◽  
Antonio Conte ◽  
Troy Labounty
Keyword(s):  
Computed Tomography ◽  
Image Quality ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Iterative Reconstruction ◽  
Transcatheter Aortic Valve Replacement ◽  
Beam Hardening ◽  
Transcatheter Aortic Valve ◽  
Blinded Reader

Background: Computed tomography (CT) is typically used to measure ileofemoral artery size in patients considered for transcatheter aortic valve replacement (TAVR). However, these patients often have significant arterial calcification, which can introduce artifacts and limit measurement accuracy. We hypothesized that improved iterative reconstruction would improve image quality and reduce artifacts, resulting in larger measured size. Methods: We examined 56 patients undergoing CT for possible TAVR, and compared image quality and ileofemoral arterial size between separate reconstructions of the same studies, comparing standard (STD) advanced statistical iterative reconstruction and improved model-based iterative reconstruction (MBIR). A blinded reader identified the sites with the smallest luminal diameter, and provided identical short-axis reformats for both reconstructions. A separate blinded reader graded image quality and made measurements in a random sequence. We compared mean and minimal diameters, image quality (1 poor, 4 excellent), and signal and noise. Results: Mean age was 77 ± 10 years and 54% were male. Table 1 compares measured diameters and image quality between STD and MBIR reconstructions. Between STD and MBIR images, ≥moderate beam-hardening artifacts were observed in 30% (17/56) and 9% (5/56) of patients, respectively (p=0.008); severe artifacts were seen in 23% (13/56) and 5% (3/56) of patients, respectively (p=0.01). Overall image quality of STD and MBIR images was graded as good or excellent in 70% (39/56) and 91% (51/56) of cases, respectively (p=0.008). Conclusion: In patients referred for TAVR, improved iterative reconstruction resulted in higher image quality, fewer beam-hardening artifacts, and larger measurements of ileofemoral artery size.

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