Geometric changes in ventriculoaortic complex after transcatheter aortic valve replacement and its association with post-procedural prosthesis-patient mismatch: An intraprocedural 3D-TEE study

Hiroto Utsunomiya, Hirotsugu Mihara, Yuji Itabashi, Sayuki Kobayashi, Robert J. Siegel, Tarun Chakravarty, Hasan Jilaihawi, Raj R. Makkar, Takahiro Shiota

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) leads to increased mortality. However, its peri-procedural determinants remain unknown. We investigated geometric changes in aortic annulus (AoA) and left ventricular outflow tract (LVOT) during TAVR by three-dimensional transoesophageal echocardiography (3D-TEE) and its association with post-procedural PPM. Methods and results A total of 131 patients with severe aortic stenosis underwent intraprocedural 3D-TEE during balloon-expandable TAVR. The severity of PPM was graded using the indexed effective orifice area calculated by Doppler echocardiography at discharge, with moderate defined as ≥0.65 and ≤0.85 cm2/m2 and severe defined as ,0.65 cm2/m2. 3D planimetered AoA area decreased after TAVR (P , 0.001), whereas the LVOT increased (P = 0.004). The eccentricity of both AoA and LVOT decreased after TAVR (both, P , 0.001). At discharge, the incidence of overall and severe PPM was 44 and 12%, respectively. Patients with PPM had a larger body surface area, smaller aortic valve area, and less frequent balloon dilation (all P , 0.05). Patients with PPM had a lower post-TAVR AoA area/pre-TAVR AoA area (91+8 vs. 95+7%, P = 0.001) than those without PPM. The post-TAVR AoA area/pre-TAVR AoA area was independently associated with overall PPM (odds ratio, 1.80; 95% CI, 1.06-3.05; P = 0.031) and severe PPM (odds ratio, 2.50; 95% CI, 1.05-5.36; P = 0.04). Additionally, a cut-off value of this ratio .86.3% had a sensitivity of 84% and a specificity of 44% for the prevention of severe PPM. Conclusion 3D-TEE can evaluate geometric changes in AoA and LVOT during balloon-expandable TAVR and predicts postprocedural PPM.

Original languageEnglish
Pages (from-to)1-10
Number of pages10
JournalEuropean Heart Journal Cardiovascular Imaging
Volume18
Issue number1
DOIs
Publication statusPublished - 2017
Externally publishedYes

Fingerprint

Prostheses and Implants
Transcatheter Aortic Valve Replacement
Odds Ratio
Three-Dimensional Echocardiography
Doppler Echocardiography
Body Surface Area
Transesophageal Echocardiography
Aortic Valve Stenosis
Aortic Valve
Dilatation

Keywords

  • Echocardiography
  • Patient mismatch
  • Prosthesis
  • Three-dimensional transoesophageal
  • Transcatheter aortic valve replacement

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Geometric changes in ventriculoaortic complex after transcatheter aortic valve replacement and its association with post-procedural prosthesis-patient mismatch : An intraprocedural 3D-TEE study. / Utsunomiya, Hiroto; Mihara, Hirotsugu; Itabashi, Yuji; Kobayashi, Sayuki; Siegel, Robert J.; Chakravarty, Tarun; Jilaihawi, Hasan; Makkar, Raj R.; Shiota, Takahiro.

In: European Heart Journal Cardiovascular Imaging, Vol. 18, No. 1, 2017, p. 1-10.

Research output: Contribution to journalArticle

Utsunomiya, Hiroto ; Mihara, Hirotsugu ; Itabashi, Yuji ; Kobayashi, Sayuki ; Siegel, Robert J. ; Chakravarty, Tarun ; Jilaihawi, Hasan ; Makkar, Raj R. ; Shiota, Takahiro. / Geometric changes in ventriculoaortic complex after transcatheter aortic valve replacement and its association with post-procedural prosthesis-patient mismatch : An intraprocedural 3D-TEE study. In: European Heart Journal Cardiovascular Imaging. 2017 ; Vol. 18, No. 1. pp. 1-10.
@article{9781ce3e29184ea1b9f26770166edc42,
title = "Geometric changes in ventriculoaortic complex after transcatheter aortic valve replacement and its association with post-procedural prosthesis-patient mismatch: An intraprocedural 3D-TEE study",
abstract = "Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) leads to increased mortality. However, its peri-procedural determinants remain unknown. We investigated geometric changes in aortic annulus (AoA) and left ventricular outflow tract (LVOT) during TAVR by three-dimensional transoesophageal echocardiography (3D-TEE) and its association with post-procedural PPM. Methods and results A total of 131 patients with severe aortic stenosis underwent intraprocedural 3D-TEE during balloon-expandable TAVR. The severity of PPM was graded using the indexed effective orifice area calculated by Doppler echocardiography at discharge, with moderate defined as ≥0.65 and ≤0.85 cm2/m2 and severe defined as ,0.65 cm2/m2. 3D planimetered AoA area decreased after TAVR (P , 0.001), whereas the LVOT increased (P = 0.004). The eccentricity of both AoA and LVOT decreased after TAVR (both, P , 0.001). At discharge, the incidence of overall and severe PPM was 44 and 12{\%}, respectively. Patients with PPM had a larger body surface area, smaller aortic valve area, and less frequent balloon dilation (all P , 0.05). Patients with PPM had a lower post-TAVR AoA area/pre-TAVR AoA area (91+8 vs. 95+7{\%}, P = 0.001) than those without PPM. The post-TAVR AoA area/pre-TAVR AoA area was independently associated with overall PPM (odds ratio, 1.80; 95{\%} CI, 1.06-3.05; P = 0.031) and severe PPM (odds ratio, 2.50; 95{\%} CI, 1.05-5.36; P = 0.04). Additionally, a cut-off value of this ratio .86.3{\%} had a sensitivity of 84{\%} and a specificity of 44{\%} for the prevention of severe PPM. Conclusion 3D-TEE can evaluate geometric changes in AoA and LVOT during balloon-expandable TAVR and predicts postprocedural PPM.",
keywords = "Echocardiography, Patient mismatch, Prosthesis, Three-dimensional transoesophageal, Transcatheter aortic valve replacement",
author = "Hiroto Utsunomiya and Hirotsugu Mihara and Yuji Itabashi and Sayuki Kobayashi and Siegel, {Robert J.} and Tarun Chakravarty and Hasan Jilaihawi and Makkar, {Raj R.} and Takahiro Shiota",
year = "2017",
doi = "10.1093/ehjci/jew039",
language = "English",
volume = "18",
pages = "1--10",
journal = "European Heart Journal Cardiovascular Imaging",
issn = "2047-2404",
publisher = "Oxford University Press",
number = "1",

}

TY - JOUR

T1 - Geometric changes in ventriculoaortic complex after transcatheter aortic valve replacement and its association with post-procedural prosthesis-patient mismatch

T2 - An intraprocedural 3D-TEE study

AU - Utsunomiya, Hiroto

AU - Mihara, Hirotsugu

AU - Itabashi, Yuji

AU - Kobayashi, Sayuki

AU - Siegel, Robert J.

AU - Chakravarty, Tarun

AU - Jilaihawi, Hasan

AU - Makkar, Raj R.

AU - Shiota, Takahiro

PY - 2017

Y1 - 2017

N2 - Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) leads to increased mortality. However, its peri-procedural determinants remain unknown. We investigated geometric changes in aortic annulus (AoA) and left ventricular outflow tract (LVOT) during TAVR by three-dimensional transoesophageal echocardiography (3D-TEE) and its association with post-procedural PPM. Methods and results A total of 131 patients with severe aortic stenosis underwent intraprocedural 3D-TEE during balloon-expandable TAVR. The severity of PPM was graded using the indexed effective orifice area calculated by Doppler echocardiography at discharge, with moderate defined as ≥0.65 and ≤0.85 cm2/m2 and severe defined as ,0.65 cm2/m2. 3D planimetered AoA area decreased after TAVR (P , 0.001), whereas the LVOT increased (P = 0.004). The eccentricity of both AoA and LVOT decreased after TAVR (both, P , 0.001). At discharge, the incidence of overall and severe PPM was 44 and 12%, respectively. Patients with PPM had a larger body surface area, smaller aortic valve area, and less frequent balloon dilation (all P , 0.05). Patients with PPM had a lower post-TAVR AoA area/pre-TAVR AoA area (91+8 vs. 95+7%, P = 0.001) than those without PPM. The post-TAVR AoA area/pre-TAVR AoA area was independently associated with overall PPM (odds ratio, 1.80; 95% CI, 1.06-3.05; P = 0.031) and severe PPM (odds ratio, 2.50; 95% CI, 1.05-5.36; P = 0.04). Additionally, a cut-off value of this ratio .86.3% had a sensitivity of 84% and a specificity of 44% for the prevention of severe PPM. Conclusion 3D-TEE can evaluate geometric changes in AoA and LVOT during balloon-expandable TAVR and predicts postprocedural PPM.

AB - Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) leads to increased mortality. However, its peri-procedural determinants remain unknown. We investigated geometric changes in aortic annulus (AoA) and left ventricular outflow tract (LVOT) during TAVR by three-dimensional transoesophageal echocardiography (3D-TEE) and its association with post-procedural PPM. Methods and results A total of 131 patients with severe aortic stenosis underwent intraprocedural 3D-TEE during balloon-expandable TAVR. The severity of PPM was graded using the indexed effective orifice area calculated by Doppler echocardiography at discharge, with moderate defined as ≥0.65 and ≤0.85 cm2/m2 and severe defined as ,0.65 cm2/m2. 3D planimetered AoA area decreased after TAVR (P , 0.001), whereas the LVOT increased (P = 0.004). The eccentricity of both AoA and LVOT decreased after TAVR (both, P , 0.001). At discharge, the incidence of overall and severe PPM was 44 and 12%, respectively. Patients with PPM had a larger body surface area, smaller aortic valve area, and less frequent balloon dilation (all P , 0.05). Patients with PPM had a lower post-TAVR AoA area/pre-TAVR AoA area (91+8 vs. 95+7%, P = 0.001) than those without PPM. The post-TAVR AoA area/pre-TAVR AoA area was independently associated with overall PPM (odds ratio, 1.80; 95% CI, 1.06-3.05; P = 0.031) and severe PPM (odds ratio, 2.50; 95% CI, 1.05-5.36; P = 0.04). Additionally, a cut-off value of this ratio .86.3% had a sensitivity of 84% and a specificity of 44% for the prevention of severe PPM. Conclusion 3D-TEE can evaluate geometric changes in AoA and LVOT during balloon-expandable TAVR and predicts postprocedural PPM.

KW - Echocardiography

KW - Patient mismatch

KW - Prosthesis

KW - Three-dimensional transoesophageal

KW - Transcatheter aortic valve replacement

UR - http://www.scopus.com/inward/record.url?scp=85019753832&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85019753832&partnerID=8YFLogxK

U2 - 10.1093/ehjci/jew039

DO - 10.1093/ehjci/jew039

M3 - Article

C2 - 27025512

AN - SCOPUS:85019753832

VL - 18

SP - 1

EP - 10

JO - European Heart Journal Cardiovascular Imaging

JF - European Heart Journal Cardiovascular Imaging

SN - 2047-2404

IS - 1

ER -