Transthoracic Echocardiography to Assess Aortic Regurgitation after TAVR: A Comparison with Periprocedural Transesophageal Echocardiography

Cardiology ◽  
2016 ◽  
Vol 137 (1) ◽  
pp. 1-8 ◽  
Author(s):  
Alexandra Goncalves ◽  
Charles Nyman ◽  
David R. Okada ◽  
Avinainder Singh ◽  
Jeffrey Swanson ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transesophageal Echocardiography ◽  
Aortic Regurgitation ◽  
Transthoracic Echocardiography ◽  
Transcatheter Aortic Valve Replacement ◽  
Transcatheter Aortic Valve ◽  
Overall Mortality

Background: We aimed to compare periprocedural transesophageal echocardiography (TEE) with postprocedural transthoracic echocardiography (TTE) for the diagnosis of aortic regurgitation (AR). Methods and Results: TEE and TTE images of 163 transcatheter aortic valve replacement (TAVR) patients (mean age 81 ± 8 years; 56% men) were reviewed separately and blinded to each other as well as to all clinical data. The median time between TEE during TAVR (TEE/TAVR) and TTE was 4 days (IQR 2-10 days). After TAVR, 48% of the patients had at least trace AR by TEE, 56% by angiography and 67% by TTE. The majority of AR was paravalvular (78%). More patients were classified with mild-to-moderate AR by TTE than by TEE (44 vs. 22%, p < 0.01). When examining the 46 patients with AR by TTE which was not at TEE/TAVR, both systolic and diastolic blood pressure (SBP and DBP) were significantly higher during TTE than during TEE (mean ΔSBP = 9 ± 4 mm Hg and mean ΔDBP = 6 ± 2 mm Hg, p < 0.01 for both). No differences in BP between TEE and TTE were found among patients with no AR or among those who had AR in both studies. At a median follow-up of 185 days (IQR 39-424 days), the overall mortality was 17%, but this was not associated with the presence of AR on TTE or TEE. Conclusions: Patients' hemodynamic conditions may result in underdiagnosis of paravalvular regurgitation in periprocedural TEE. Our findings suggest that a postprocedural evaluation for AR by TTE could serve as a reasonable alternative to TEE for the evaluation of AR.

Abstract 12320: Assessment of Post-Procedural Aortic Regurgitation After Transcatheter Aortic Valve Replacement During the Procedure: An Intraprocedural Transesophageal Echocardiography Study

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Hirotsugu Mihara ◽  
Kentaro Shibayama ◽  
Hasan Jilaihawi ◽  
Yuji Itabashi ◽  
Javier Berdejo ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Transesophageal Echocardiography ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Color Doppler ◽  
Descending Aorta ◽  
Transcatheter Aortic Valve ◽  
Pulsed Wave Doppler

Introduction: The assessment of post-procedual aortic regurgitation (PAR) after transcatheter aortic valve replacement (TAVR) has not been validated. The purpose of this study was (1) to investigate the value of holodiastolic flow reversal (HDFR) in the descending aorta in patients with PAR after TAVR and (2) to determine which color Doppler parameters are useful for PAR grading using the intraprocedural transesophageal echocardiography (iTEE). Hypothesis: We hypothesized that HDFR in the descending aorta and any color Doppler parameters can delineate significant PAR after TAVR. Methods: Three hundred-eighty patients with severe aortic stenosis underwent TAVR with the Edwards SAPIEN valve with 131 pulsed-wave Doppler tracings from the descending aorta had assessed by iTEE. PAR was evaluated using 2D color Doppler by the cross-sectional area of the vena contracta (VCA) at the aortic annular plane, and by the longitudinal jet extent (mosaic signals, Figure A) compared to the location of the tip of the anterior mitral leaflet (AML). Significant PAR was defined as VCA of ≥10 mm2, corresponding to greater than a moderate grade. Results: In patients with any grade of PAR, pulsed-wave Doppler tracing from the descending aorta, jet extent and VCA were obtained in 100%, 80%, and 74%, respectively. All patients with consistent HDFR had significant PAR. By multivariate analysis, a consistent HDFR and jet extent beyond the tip of AML were independent predictors of significant PAR. A consistent HDFR and jet extent beyond the tip of AML predicted significant PAR with specificity of 100% and 97%, respectively. In the other hand, patients with both negative HDFR and jet extent of less than halfway to the tip of AML had no significant PAR with a 97% specificity. Conclusions: The presence of HDFR with each cardiac cycle and jet extent beyond the tip of AML are indicative of significant PAR.

scholarly journals Early haemodynamic and structural impact of transcatheter aortic valve replacement in pure aortic regurgitation

2020 ◽  
Vol 41 (Supplement_2) ◽  
Author(s):  
F Graziani ◽  
E Mencarelli ◽  
F Burzotta ◽  
L Paraggio ◽  
C Aurigemma ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Aortic Regurgitation ◽  
Valve Replacement ◽  
Transcatheter Aortic Valve Replacement ◽  
Left Ventricular ◽  
Transcatheter Aortic Valve ◽  
Structural Impact ◽  
Before And After

Abstract Background Patients with severe aortic regurgitation (AR) are treated by surgery and have variable left-ventricular (LV) “reverse remodelling” after intervention. Transcatheter-aortic-valve replacement (TAVR) might be considered in selected AR patients. Purpose To evaluate the hemodynamic and structural impact of TAVR in patients with pure AR. Methods Consecutive AR patients underwent TAVR in our Institution were identified. Left heart catheterization before and after TAVR and complete echocardiographic assessment before TAVR, after (24–72 hours) TAVR and at follow-up (3–12 months) were systematically performed. Hemodynamic and echocardiographic parameters were compared before and after TAVR. Results Twenty-two patients with severe AR, high surgical risk and advanced heart damage were treated by TAVR using mainly self-expandable prostheses. The procedure was successful in 21 patients (95.5%). An immediate hemodynamic impact of the TAVR procedure was documented by different parameters and included significant decrease in LV end-diastolic pressure (from 26.2 to 20.1 mmHg, P=0.012). Significant reduction in LV size (left ventricular end diastolic diameter (LVEDD): 60.0±8.0 mm vs 54.6±8.1 mm, p=0.002) and mass (left ventricular mass indexed (LVMi): 163.2±58.8 g/m2 vs 140.2±45.6 g/m2, p 0.004) as well as a sharp reduction in systolic-pulmonary-arterial-pressure (48.3±17.6 vs 32.9±7.8 mmHg, p&lt;0.0001) was documented at 24–72 hours. Furthermore, patients with baseline moderate-to-severe mitral and tricuspid regurgitation showed a significant, early, valvular regurgitation reduction. All favourable changes persisted at follow-up. More pronounced LVEDD reduction was predicted by baseline LVEDD (p=0.019). Conclusions In patients with severe AR, TAVR determines a profound impact on heart remodelling, which is early detectable and durable. Impact of TAVR in pure AR Funding Acknowledgement Type of funding source: None

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