Evaluation of a Low-Dose Radiation Protocol During Transcatheter Aortic Valve Implantation

• Published in: The American journal of cardiology Vol. 139; pp. 71 - 78
• Main Authors: Michel, Jonathan M., Hashorva, Desard, Kretschmer, Angela, Alvarez-Covarrubias, Hector A., Mayr, N. Patrick, Pellegrini, Costanza, Rheude, Tobias, Frangieh, Antonio H., Giacoppo, Daniele, Kastrati, Adnan, Schunkert, Heribert, Xhepa, Erion, Joner, Michael, Kasel, A. Markus
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 15.01.2021; Elsevier Limited
• Subjects: Aged; Aged, 80 and over; Aluminum; Angioplasty; Aorta; Aortic valve; Aortic Valve - surgery; Aortic Valve Stenosis - diagnosis; Aortic Valve Stenosis - surgery; Balloon treatment; Body mass index; Cardiovascular disease; Complications; Copper; Dose-Response Relationship, Radiation; FDA approval; Female; Fluoroscopy; Fluoroscopy - methods; Heart; Heart valves; Humans; Imaging; Implantation; Intubation; Laboratories; Male; Mortality; Multivariate analysis; Patients; Product safety; Prognosis; Prostheses; Radiation; Radiation dosage; Radiation Injuries - prevention & control; Retrospective Studies; Risk Factors; Sensors; Surgery, Computer-Assisted - methods; Transcatheter Aortic Valve Replacement - methods
• ISSN: 0002-9149; 1879-1913
• DOI: 10.1016/j.amjcard.2020.10.035

We aimed to evaluate the efficacy and safety of a low-dose imaging protocol to reduce intraprocedural radiation during transcatheter aortic valve implantation (TAVI). Observational analysis: 802 transfemoral TAVI patients receiving balloon-expandable devices ≥23 mm at a high-volume centre. After propensity score matching, a standard-dose group (SD, n = 333) treated between January 2014 and February 2016 was compared with a low-dose group (LD, n = 333) treated between August 2017 and March 2019 after departmental uptake of a low-dose imaging protocol (reduced field size, high table height, use of “fluoro save,” 3.75 frames/second acquisition, increased filtering). Primary end point was dose-area product (DAP). Secondary safety end points were VARC-2 device success and a composite of in-hospital complications. The LD protocol was associated with lower DAP (4.64 [2.93, 8.42] vs 22.73 [12.31, 34.58] Gy⋅cm2, p <0.001) and fluoroscopy time (10.4 [8.1, 13.9] vs 11.5 [9.1, 15.3] minutes, p = 0.001). Contrast use was higher in the LD group (LD 110 [94, 130] vs SD 100 [80, 135] milliliters, p = 0.042). Device success (LD 88.3% vs SD 91.3%, p = 0.25), and the composite end point (LD 8.1% vs SD 11.4%, p = 0.19) were similar. In multivariate analysis, the low-dose protocol was associated with a 19.8 Gy⋅cm2 reduction in procedural DAP (p <0.001). In conclusion, compared with standard imaging, a low-dose protocol for TAVI significantly reduced radiation dose without compromising outcomes.