TY - JOUR
T1 - Assessment of Post-Procedural Aortic Regurgitation after TAVR An Intraprocedural TEE Study
AU - Mihara, Hirotsugu
AU - Shibayama, Kentaro
AU - Jilaihawi, Hasan
AU - Itabashi, Yuji
AU - Berdejo, Javier
AU - Utsunomiya, Hiroto
AU - Siegel, Robert J.
AU - Makkar, Raj R.
AU - Shiota, Takahiro
N1 - Funding Information:
Dr. Jilaihawi is a consultant for Edwards Lifesciences, St. Jude Medical, and Venus Medtech. Dr. Siegel is a consultant for Abbott; and is a member of the Speakers Bureau for Philips Ultrasound. Dr. Makkar has received research grants from Cordis, Edwards Lifesciences, Medtronic, Abbott Vascular, Capricor, and St. Jude Medical; is a proctor for Edwards; and is a consultant for Medtronic. Dr. Shiota is a speaker for Philips Ultrasound. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Publisher Copyright:
© 2015 American College of Cardiology Foundation.
PY - 2015/9/1
Y1 - 2015/9/1
N2 - Objectives The purpose of this study was to determine which echocardiographic parameters, including holodiastolic flow reversal (HDFR) in the descending aorta, were useful for grading of post-procedural aortic regurgitation (PAR) after transcatheter aortic valve replacement (TAVR) using intraprocedural transesophageal echocardiography. Background Reliable assessment of PAR in a catheterization laboratory is essential for an optimal outcome after TAVR; however, such an assessment has not been determined. Methods Three hundred eighty patients who underwent TAVR with the Edwards (Irvine, California) balloon-expandable transcatheter heart valve were retrospectively assessed by intraprocedural transesophageal echocardiography. PAR was evaluated by 2-dimensional color Doppler and pulse-wave Doppler in the descending aorta. Using 2-dimensional color Doppler, we measured the cross-sectional area of the vena contracta, the circumferential extent at the aortic annular plane, the longitudinal jet length, and the jet extent (with a mosaic pattern in the left ventricular outflow tract) compared with the location of the tip of the anterior mitral leaflet (AML). Grading of PAR was determined using the following vena contracta cutoffs: mild ≤9 mm;be moderate 10 to 29 mm;be and severe ≥30 mm;be. Significant PAR was defined as at least moderate grade. Results All patients with consistent HDFR had significant PAR. By multivariable analysis, consistent HDFR and the jet extent beyond the tip of AML were independent predictors of significant PAR. Consistent HDFR and jet extent beyond the tip of AML predicted significant PAR with specificities of 100% and 97%, respectively. In contrast, patients with both negative HDFR and a jet extent of less than halfway to the tip of AML had no significant PAR, with 97% specificity. Conclusions The presence of consistent HDFR and jet extent beyond the tip of AML are indicative of significant PAR after TAVR.
AB - Objectives The purpose of this study was to determine which echocardiographic parameters, including holodiastolic flow reversal (HDFR) in the descending aorta, were useful for grading of post-procedural aortic regurgitation (PAR) after transcatheter aortic valve replacement (TAVR) using intraprocedural transesophageal echocardiography. Background Reliable assessment of PAR in a catheterization laboratory is essential for an optimal outcome after TAVR; however, such an assessment has not been determined. Methods Three hundred eighty patients who underwent TAVR with the Edwards (Irvine, California) balloon-expandable transcatheter heart valve were retrospectively assessed by intraprocedural transesophageal echocardiography. PAR was evaluated by 2-dimensional color Doppler and pulse-wave Doppler in the descending aorta. Using 2-dimensional color Doppler, we measured the cross-sectional area of the vena contracta, the circumferential extent at the aortic annular plane, the longitudinal jet length, and the jet extent (with a mosaic pattern in the left ventricular outflow tract) compared with the location of the tip of the anterior mitral leaflet (AML). Grading of PAR was determined using the following vena contracta cutoffs: mild ≤9 mm;be moderate 10 to 29 mm;be and severe ≥30 mm;be. Significant PAR was defined as at least moderate grade. Results All patients with consistent HDFR had significant PAR. By multivariable analysis, consistent HDFR and the jet extent beyond the tip of AML were independent predictors of significant PAR. Consistent HDFR and jet extent beyond the tip of AML predicted significant PAR with specificities of 100% and 97%, respectively. In contrast, patients with both negative HDFR and a jet extent of less than halfway to the tip of AML had no significant PAR, with 97% specificity. Conclusions The presence of consistent HDFR and jet extent beyond the tip of AML are indicative of significant PAR after TAVR.
KW - aortic stenosis
KW - paravalvular regurgitation
KW - transcatheter aortic valve replacement
KW - transesophageal echocardiography
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U2 - 10.1016/j.jcmg.2015.02.029
DO - 10.1016/j.jcmg.2015.02.029
M3 - Article
C2 - 26319501
AN - SCOPUS:84942599515
SN - 1936-878X
VL - 8
SP - 993
EP - 1003
JO - JACC: Cardiovascular Imaging
JF - JACC: Cardiovascular Imaging
IS - 9
ER -