Reducing radiation exposure during transcatheter aortic valve implantation (TAVI)

• Published in: Catheterization and cardiovascular interventions Vol. 85; no. 7; pp. 1256 - 1261
• Main Authors: Sharma, Divyesh, Ramsewak, Adesh, O'Conaire, Sean, Manoharan, Ganesh, Spence, Mark S.
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01.06.2015; Wiley Subscription Services, Inc
• Subjects: Aged; Aged, 80 and over; aortic stenosis; Aortic Valve - diagnostic imaging; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - therapy; Cardiac Catheterization - adverse effects; Cardiac Catheterization - methods; Female; Femoral Artery - diagnostic imaging; Heart Valve Prosthesis Implantation - adverse effects; Heart Valve Prosthesis Implantation - methods; Humans; Male; Middle Aged; Northern Ireland; Patient Safety; Radiation Dosage; radiation dose; Radiation Exposure - prevention & control; Radiation Injuries - etiology; Radiation Injuries - prevention & control; Radiography, Interventional - adverse effects; Radiography, Interventional - methods; Risk Assessment; Risk Factors; TAVI; transcatheter aortic valve implantation; transfemoral; Treatment Outcome; transcatheter aortic valve implantation; aortic stenosis; radiation dose; transfemoral; TAVI
• ISSN: 1522-1946; 1522-726X
• DOI: 10.1002/ccd.25363

Objectives To establish radiation dose and determine the effect of changes in cine‐fluoroscopic image acquisition settings on radiation dose and procedural outcomes in consecutive patients undergoing transcatheter aortic valve implantation (TAVI). Background The radiation dose during TAVI has not been extensively investigated. Methods to keep doses as low as reasonably achievable should be established for the safety of both the patient and the interventional team involved. Methods Data on radiation exposure was collected for 36 consecutive patients undergoing TAVI using standard image acquisition settings (SS) and 36 consecutive patients using modified image acquisition settings (LS). Radiation dose was recorded using an integrated dosimeter as dose area product (DAP). Data on patient characteristics, screening time, procedure time, contrast volume, and procedural outcomes were recorded prospectively. We also collected radiation dose data on 40 consecutive patients undergoing percutaneous coronary intervention in the same catheterisation laboratory. Results The median DAP for the LS group was significantly lower at 74.6 Gy*cm2 compared to a dose of 102.4 Gy*cm2 for the SS group (P = 0.008). There were no significant differences in the screening times, procedure times, and contrast volume used. Overall, there was no difference in procedural outcomes between the two groups. The radiation dose for TAVI procedures (SS group) was comparable to PCI procedures (102.4 Gy*cm2 vs. 94.6 Gy*cm2) using the same settings in the same catheterisation laboratory. Conclusions This study demonstrates that the radiation exposure to the patient can be significantly and simply reduced using modified dose acquisition settings for TAVI without affecting procedural outcomes. © 2015 Wiley Periodicals, Inc.