3D Assessment of Features Associated With Transvalvular Aortic Regurgitation After TAVR: A Real-Time 3D TEE Study

Kentaro Shibayama, Hirotsugu Mihara, Hasan Jilaihawi, Javier Berdejo, Kenji Harada, Yuji Itabashi, Robert Siegel, Raj R. Makkar, Takahiro Shiota

Research output: Contribution to journalArticle

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Abstract

Objectives This study of 3-dimensional (3D) transesophageal echocardiography (TEE) aimed to demonstrate features associated with transvalvular aortic regurgitation (AR) after transcatheter aortic valve replacement (TAVR) and to confirm the fact that a gap between the native aortic annulus and prosthesis is associated with paravalvular AR. Background The mechanism of AR after TAVR, particularly that of transvalvular AR, has not been evaluated adequately. Methods All patients with severe aortic stenosis who underwent TAVR with the Sapien device (Edwards Lifesciences, Irvine, California) had 3D TEE of the pre-procedural native aortic annulus and the post-procedural prosthetic valve. Results In the 201 patients studied, the total AR was mild in 67 patients (33%), moderate in 21 patients (10%), and severe in no patients. There were 20 patients with transvalvular AR and 82 patients with paravalvular AR. Fourteen patients had both transvalvular and paravalvular AR. Patients with transvalvular AR had larger prosthetic expansion (p <0.05), a more elliptical prosthetic shape at the prosthetic commissure level (p <0.01) and more anti-anatomical position (p <0.001), which was defined as malposition of the prosthetic commissures in relation to the native commissures, than the patients without transvalvular AR. Age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.01 to 1.09; p < 0.05) and effective area oversizing (OR: 0.97; 95% CI: 0.93 to 0.99, p <0.05) were associated with mild or greater paravalvular AR. Conclusions 3D TEE successfully demonstrated the features associated with transvalvular AR, such as large prosthetic expansion, elliptical prosthetic shape, and anti-anatomical position of prosthesis. Additionally, effective area oversizing was associated with paravalvular AR.

Original languageEnglish
Pages (from-to)114-123
Number of pages10
JournalJACC: Cardiovascular Imaging
Volume9
Issue number2
DOIs
Publication statusPublished - 2016 Feb 1
Externally publishedYes

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Aortic Valve Insufficiency
Transesophageal Echocardiography
Transcatheter Aortic Valve Replacement
Prostheses and Implants
Odds Ratio
Confidence Intervals
Aortic Valve Stenosis

Keywords

  • aortic valve
  • aortic valve insufficiency
  • echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging

Cite this

3D Assessment of Features Associated With Transvalvular Aortic Regurgitation After TAVR : A Real-Time 3D TEE Study. / Shibayama, Kentaro; Mihara, Hirotsugu; Jilaihawi, Hasan; Berdejo, Javier; Harada, Kenji; Itabashi, Yuji; Siegel, Robert; Makkar, Raj R.; Shiota, Takahiro.

In: JACC: Cardiovascular Imaging, Vol. 9, No. 2, 01.02.2016, p. 114-123.

Research output: Contribution to journalArticle

Shibayama, K, Mihara, H, Jilaihawi, H, Berdejo, J, Harada, K, Itabashi, Y, Siegel, R, Makkar, RR & Shiota, T 2016, '3D Assessment of Features Associated With Transvalvular Aortic Regurgitation After TAVR: A Real-Time 3D TEE Study', JACC: Cardiovascular Imaging, vol. 9, no. 2, pp. 114-123. https://doi.org/10.1016/j.jcmg.2015.05.012
Shibayama, Kentaro ; Mihara, Hirotsugu ; Jilaihawi, Hasan ; Berdejo, Javier ; Harada, Kenji ; Itabashi, Yuji ; Siegel, Robert ; Makkar, Raj R. ; Shiota, Takahiro. / 3D Assessment of Features Associated With Transvalvular Aortic Regurgitation After TAVR : A Real-Time 3D TEE Study. In: JACC: Cardiovascular Imaging. 2016 ; Vol. 9, No. 2. pp. 114-123.
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abstract = "Objectives This study of 3-dimensional (3D) transesophageal echocardiography (TEE) aimed to demonstrate features associated with transvalvular aortic regurgitation (AR) after transcatheter aortic valve replacement (TAVR) and to confirm the fact that a gap between the native aortic annulus and prosthesis is associated with paravalvular AR. Background The mechanism of AR after TAVR, particularly that of transvalvular AR, has not been evaluated adequately. Methods All patients with severe aortic stenosis who underwent TAVR with the Sapien device (Edwards Lifesciences, Irvine, California) had 3D TEE of the pre-procedural native aortic annulus and the post-procedural prosthetic valve. Results In the 201 patients studied, the total AR was mild in 67 patients (33{\%}), moderate in 21 patients (10{\%}), and severe in no patients. There were 20 patients with transvalvular AR and 82 patients with paravalvular AR. Fourteen patients had both transvalvular and paravalvular AR. Patients with transvalvular AR had larger prosthetic expansion (p <0.05), a more elliptical prosthetic shape at the prosthetic commissure level (p <0.01) and more anti-anatomical position (p <0.001), which was defined as malposition of the prosthetic commissures in relation to the native commissures, than the patients without transvalvular AR. Age (odds ratio [OR]: 1.05; 95{\%} confidence interval [CI]: 1.01 to 1.09; p < 0.05) and effective area oversizing (OR: 0.97; 95{\%} CI: 0.93 to 0.99, p <0.05) were associated with mild or greater paravalvular AR. Conclusions 3D TEE successfully demonstrated the features associated with transvalvular AR, such as large prosthetic expansion, elliptical prosthetic shape, and anti-anatomical position of prosthesis. Additionally, effective area oversizing was associated with paravalvular AR.",
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T2 - A Real-Time 3D TEE Study

AU - Shibayama, Kentaro

AU - Mihara, Hirotsugu

AU - Jilaihawi, Hasan

AU - Berdejo, Javier

AU - Harada, Kenji

AU - Itabashi, Yuji

AU - Siegel, Robert

AU - Makkar, Raj R.

AU - Shiota, Takahiro

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N2 - Objectives This study of 3-dimensional (3D) transesophageal echocardiography (TEE) aimed to demonstrate features associated with transvalvular aortic regurgitation (AR) after transcatheter aortic valve replacement (TAVR) and to confirm the fact that a gap between the native aortic annulus and prosthesis is associated with paravalvular AR. Background The mechanism of AR after TAVR, particularly that of transvalvular AR, has not been evaluated adequately. Methods All patients with severe aortic stenosis who underwent TAVR with the Sapien device (Edwards Lifesciences, Irvine, California) had 3D TEE of the pre-procedural native aortic annulus and the post-procedural prosthetic valve. Results In the 201 patients studied, the total AR was mild in 67 patients (33%), moderate in 21 patients (10%), and severe in no patients. There were 20 patients with transvalvular AR and 82 patients with paravalvular AR. Fourteen patients had both transvalvular and paravalvular AR. Patients with transvalvular AR had larger prosthetic expansion (p <0.05), a more elliptical prosthetic shape at the prosthetic commissure level (p <0.01) and more anti-anatomical position (p <0.001), which was defined as malposition of the prosthetic commissures in relation to the native commissures, than the patients without transvalvular AR. Age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.01 to 1.09; p < 0.05) and effective area oversizing (OR: 0.97; 95% CI: 0.93 to 0.99, p <0.05) were associated with mild or greater paravalvular AR. Conclusions 3D TEE successfully demonstrated the features associated with transvalvular AR, such as large prosthetic expansion, elliptical prosthetic shape, and anti-anatomical position of prosthesis. Additionally, effective area oversizing was associated with paravalvular AR.

AB - Objectives This study of 3-dimensional (3D) transesophageal echocardiography (TEE) aimed to demonstrate features associated with transvalvular aortic regurgitation (AR) after transcatheter aortic valve replacement (TAVR) and to confirm the fact that a gap between the native aortic annulus and prosthesis is associated with paravalvular AR. Background The mechanism of AR after TAVR, particularly that of transvalvular AR, has not been evaluated adequately. Methods All patients with severe aortic stenosis who underwent TAVR with the Sapien device (Edwards Lifesciences, Irvine, California) had 3D TEE of the pre-procedural native aortic annulus and the post-procedural prosthetic valve. Results In the 201 patients studied, the total AR was mild in 67 patients (33%), moderate in 21 patients (10%), and severe in no patients. There were 20 patients with transvalvular AR and 82 patients with paravalvular AR. Fourteen patients had both transvalvular and paravalvular AR. Patients with transvalvular AR had larger prosthetic expansion (p <0.05), a more elliptical prosthetic shape at the prosthetic commissure level (p <0.01) and more anti-anatomical position (p <0.001), which was defined as malposition of the prosthetic commissures in relation to the native commissures, than the patients without transvalvular AR. Age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.01 to 1.09; p < 0.05) and effective area oversizing (OR: 0.97; 95% CI: 0.93 to 0.99, p <0.05) were associated with mild or greater paravalvular AR. Conclusions 3D TEE successfully demonstrated the features associated with transvalvular AR, such as large prosthetic expansion, elliptical prosthetic shape, and anti-anatomical position of prosthesis. Additionally, effective area oversizing was associated with paravalvular AR.

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