Core Lab Adjudication of the ACURATE neo2 Hemodynamic Performance Using Computed-Tomography-Corrected Left...

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Conventional 2D transthoracic Echocardiography-Doppler (2D-TTE) has limitations in assessing prosthetic heart valve hemodynamics, particularly in measuring the left ventricular outflow tract (LVOT) area, which assumes a circular shape.
• Accurate hemodynamic assessment is crucial for evaluating outcomes after transcatheter aortic valve implantation (TAVI).
• Prosthesis-patient mismatch (PPM) can affect long-term outcomes and is influenced by accurate LVOT area measurement.

Purpose of the Study:

• To compare the accuracy of 2D-TTE versus 3D-MDCT for measuring LVOT area and its impact on hemodynamic parameters and PPM incidence in patients receiving the ACURATE neo2 TAVI device.
• To evaluate the effectiveness of a corrected continuity equation using 3D-LVOT area from MDCT combined with TTE Doppler parameters for improved hemodynamic assessment.

Main Methods:

• A study involving 258 patients with severe aortic stenosis treated with the ACURATE neo2 valve.
• LVOT area and Doppler-derived parameters (EOA, SV) were calculated using post-TAVI 2D-TTE.
• 3D-LVOT area was obtained from pre-procedural MDCT scans to calculate corrected Doppler parameters and compare PPM incidence between 2D-TTE and 3D-MDCT methods.

Main Results:

• 2D-TTE significantly underestimated LVOT area (350.4 mm² vs. 405.22 mm²) and consequently EOA and SV compared to 3D-MDCT.
• PPM incidence was higher with 2D-TTE-based measurements (8.52%) than with 3D-MDCT-corrected measurements (2.32%).
• Significant differences in EOA among ACURATE neo2 valve sizes were observed with MDCT but not with 2D-TTE.

Conclusions:

• Combining 3D-LVOT area from MDCT with TTE Doppler parameters offers a more accurate hemodynamic assessment and PPM diagnosis in TAVI patients.
• The ACURATE neo2 THV demonstrates a large EOA and low PPM incidence when assessed using 3D-corrected LVOT area.
• Further long-term follow-up studies are needed to confirm these findings.