Reducing radiation exposure during transcatheter aortic valve implantation (TAVI)

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).

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.

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.

The median DAP for the LS group was significantly lower at 74.6 Gy*cm(2) compared to a dose of 102.4 Gy*cm(2) 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*cm(2) vs. 94.6 Gy*cm(2) ) using the same settings in the same catheterisation laboratory.

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.