PMID- 24525856
OWN - NLM
STAT- MEDLINE
DCOM- 20141208
LR  - 20161125
IS  - 1569-9285 (Electronic)
IS  - 1569-9285 (Linking)
VI  - 18
IP  - 5
DP  - 2014 May
TI  - Safety considerations during transapical aortic valve implantation.
PG  - 574-9
LID - 10.1093/icvts/ivt560 [doi]
AB  - OBJECTIVES: Transcatheter aortic valve implantation (TAVI) is a new method for 
      the treatment of very high-risk patients with aortic valve stenosis. The 
      radiation dose to which the patient and each member of the heart team are exposed 
      during this new fluoroscopically guided intervention is unknown. METHODS: Between 
      April 2008 and August 2013, 1177 consecutive patients underwent transapical TAVI 
      (TA-TAVI). In 22 consecutive patients undergoing TA-TAVI, the radiation doses to 
      the cardiothoracic surgeon, cardiologist, anaesthesiologist (performing 
      echocardiography examination), surgical assistant and nurse were measured. The 
      radiation dose measurements were performed during TAVI using thermoluminescence 
      and film dosimeters positioned on seven parts of the body: (i) chest above the 
      lead apron, (ii) pelvic area below the apron, (iii) chest below the apron, (iv) 
      thyroid gland above the apron, (v) near eyes, (vi) hands (using rings) and (vii) 
      the feet. The results were compared with the values given in the international 
      literature on recommended radiation dose limits for workers. RESULTS: The mean 
      radiation time was 6.1 min and the mean dose-area product for the patients was 
      8.661 microGy . m(2). Analysis of the dosimeters and the calculation of the effective 
      dose showed a per intervention dose of 0.03 mSv for the surgeon, 0.05 mSv for the 
      assistant, 0.02 mSv for the cardiologist and the anaesthesiologist and 0.001 mSv 
      for the nurse. The maximum ionizing radiation per intervention was 0.5 mSv at the 
      right hand of the surgeon (holding the introducer sheet) and 0.7 mSv at the left 
      hand of the surgical assistant. Additionally, the analysis of the body dose shows 
      a maximum dose to the lower leg of the surgeon (0.3 mSv) and the genital area of 
      the assistant (0.06 mSv). CONCLUSIONS: During a TA-TAVI procedure, the patients 
      receive a higher X-ray dose than during coronary angiography with intervention. 
      After 100 TAVI procedures, the members of the heart team sustain a comparable 
      dose of ionizing radiation to the annual dose received by a busy interventional 
      cardiologist. Therefore, maximal safety and optimal X-ray protection for patients 
      and the members of the team are crucial and should be redefined.
FAU - Drews, Thorsten
AU  - Drews T
AD  - Deutsches Herzzentrum Berlin, Berlin, Germany.
FAU - Pasic, Miralem
AU  - Pasic M
FAU - Juran, Ralf
AU  - Juran R
FAU - Unbehaun, Axel
AU  - Unbehaun A
FAU - Dreysse, Stephan
AU  - Dreysse S
FAU - Kukucka, Marian
AU  - Kukucka M
FAU - Mladenow, Alexander
AU  - Mladenow A
FAU - Hetzer, Roland
AU  - Hetzer R
FAU - Buz, Semih
AU  - Buz S
LA  - eng
PT  - Journal Article
DEP - 20140212
PL  - England
TA  - Interact Cardiovasc Thorac Surg
JT  - Interactive cardiovascular and thoracic surgery
JID - 101158399
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve Stenosis/diagnostic imaging/*therapy
MH  - *Cardiac Catheterization/adverse effects
MH  - Female
MH  - Film Dosimetry
MH  - Heart Valve Prosthesis Implantation/adverse effects/*methods
MH  - Humans
MH  - Male
MH  - Occupational Exposure
MH  - Occupational Health
MH  - Patient Care Team
MH  - Patient Safety
MH  - Radiation Dosage
MH  - Radiation Injuries/etiology/prevention & control
MH  - Radiation Protection
MH  - *Radiography, Interventional/adverse effects
MH  - Risk Assessment
MH  - Risk Factors
MH  - Thermoluminescent Dosimetry
MH  - Time Factors
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Aortic valve
OT  - Radiation
OT  - Safety
OT  - Transapical aortic valve implantation
OT  - Transcatheter aortic valve implantation
OT  - Valves
OT  - X-ray
EDAT- 2014/02/15 06:00
MHDA- 2014/12/15 06:00
CRDT- 2014/02/15 06:00
PHST- 2014/02/15 06:00 [entrez]
PHST- 2014/02/15 06:00 [pubmed]
PHST- 2014/12/15 06:00 [medline]
AID - ivt560 [pii]
AID - 10.1093/icvts/ivt560 [doi]
PST - ppublish
SO  - Interact Cardiovasc Thorac Surg. 2014 May;18(5):574-9. doi: 10.1093/icvts/ivt560. 
      Epub 2014 Feb 12.