a discrepancy between ct angiography and transesophageal echocardiographic measurements of the annular size affect long-term survival following trans-catheter aortic valve replacement

Introduction: accurate measurement of the aortic valve annulus is critical for proper valve sizing for the transcatheter aortic valve replacement (tavr) procedure. while computed tomography angiography (cta) is the widely-accepted standard, two-dimensional (2d) and three-dimensional (3d) transesophageal echocardiography (tee) is commonly performed to measure the size of the aortic valve and to verify appropriate seating of prostheses. methods: patients undergoing tavr between 2013-2015 were examined. 2d- and 3d-tee measurements were compared to cta taken as standard. patients were followed for at least one year. the presence and effect of discrepancy (defined as a difference of more than 10%) between cta and tee measurements on survival were examined. results: one hundred eighty-five patients (70 men) were included. 2d- and 3d-tee measurements underestimated the annulus size by -1.49 and -1.32 mm, respectively. discrepancies > 10% between tee and cta methods in estimating the aortic annulus size were associated with a decrease in postimplant survival. the peak pressure gradient across the aortic prosthesis measured one year after the implant was higher in patients with an initial discrepancy between 3d-tee and cta measurements. in a multivariate cox-regression model, the discrepancy between cta and 2d-tee readings and the smaller size of the aortic annular area were the predictors of long-term survival. conclusion: both 2d and 3d-tee underestimate the aortic annulus measurements compared to cta, with 2d-tee being relatively more precise than 3d-tee technology. the presence of a discrepancy between echocardiographic and cta measurements of the aortic annulus is associated with a lower survival rate.