Pre-TAVI aortic annulus sizing: comparison between manual and semi-automated new generation software measurements in operators with different experience

Transcatheter aortic valve implantation (TAVI) is a widely established treatment strategy for patients with symptomatic, severe aortic stenosis (AS) who are at both intermediate and high risk for conventional surgical valve replacement.1,2 Nevertheless, not every patient considered at high- risk for surgery is suitable for TAVI. In addition to individual clinical risk scores, specific technical and anatomic criteria must be met because preprocedural annular sizing is performed on the basis of non- invasive imaging findings.3 Advances in non- invasive imaging have extensively supported growth of the field because the opportunity to have an accurate integration of advanced non- invasive imaging into patient selection, treatment planning, device selec tion, and device positioning. In this context, Computed Tomography (CT) has been demonstrated to be the gold standard noninvasive tool for annular sizing, evaluation of risk of annular injury, coronary occlusion, besides BJR for peripheral access assessment.4 Nevertheless, pre- TAVI CT analysis requires accurate and time- consuming manual measurements that should be performed by experienced oper ator to ensure accuracy and reproducibility