Radiation Exposure and Contrast Volume Differ between Transapical and Transfemoral Aortic Valve Implantation with the Edwards SAPIEN Aortic Valve

Abstract

Background To date, little is known about the radiation exposure and the amount of contrast medium given during the transcatheter aortic valve implantation (TAVI) procedure. This study compares our data between the transfemoral (TF) approach and the transapical (TA) approach.

Patients and Methods A total of 216 TA and 180 TF implantations of the Edwards SAPIEN (Edwards Lifesciences, Irvine, California, United States) valve were consecutively performed by our heart team, consisting of cardiac surgeons and cardiologists. Fluoroscopy time, dose area product, and contrast volume were compared between both the approaches.

Results TF-TAVI showed higher values of fluoroscopy time (13.1 ± 5.9 vs. 7.0 ± 5.7 minutes, p < 0.001), dose area product (5.0 ± 3.9 vs. 2.7 ± 1.9 mGy·m², p < 0.001), and contrast volume (196.7 ± 72.7 vs. 109.2 ± 33.8 mL, p < 0.001). All physicians performing the TF approach exceeded the mean values of the surgeons performing the TA approach. Some physicians showed a trend toward lower values with growing experience. Vascular complications and postdilatation had only a minor impact on the study parameters.

Conclusion TA-TAVI showed an advantage over TF-TAVI in terms of lower fluoroscopy time, dose area product, and contrast use. This was hardly reflected in the past and should be considered when comparing invasiveness of both methods. However, human factors also play a role as most physicians showed a learning curve toward lower values over time.

Keywords

aortic valve and root - heart valve - transapical - percutaneous (TAVI) - imaging (all modalities)

Note

This work was presented at the Joint Meeting of the German Society for Thoracic and Cardiovascular Surgery and the German Society for Cardiovascular Engineering in Nuremberg, Germany, on November 23, 2013.

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