The effect of X‐ray beam distortion on the Edwards Sapien XT™ trans‐catheter aortic valve replacement prosthesis

Introduction Profiling the Aortic root perpendicular to the fluoroscopic image plane will achieve a more successful implant position for trans‐catheter aortic valve replacement (TAVR). This study aimed to investigate whether the divergent nature of the X‐ray beam from the C‐arm altered the appearance of the TAVR device. Methods Under bench‐top testing, a 23, 26 and 29 mm Edwards Sapien XT valve was positioned coaxially at the bottom of a fluoroscopic image utilising 22 and 32 cm fields of view (FOV). The table was then moved so that the valve was positioned at the top of the image. The valve's appearance was scored using a previously published three tier classification tool (excellent, satisfactory and poor) and quantified with measurements. The number of degrees of C‐arm rotation that were required to bring the valve back to a coaxial appearance was recorded. Results When using the 32 cm FOV, the valve's appearance changes from excellent to satisfactory. When a 22 cm FOV was used, the change is less marked. More C‐arm rotation is required to bring the appearance back to coaxial with the 32 cm FOV. Conclusion Not maintaining the valve in the centre of the image can distort the valves appearance. This has the potential to affect the final implantation depth. Trans‐catheter aortic valve replacement (TAVR) prosthesis requires accurate placement in the aortic annulus. This requires the valve to be aligned perpendicular to the X‐ray beam. This study investigates the impact of the fluoroscopic beam distortion on TAVR devices and discusses how that may affect the implant of the device.