Article Text
Abstract
Background Post-procedural aortic regurgitation (AR) has been described in a large number of patients receiving transcatheter aortic valve implantation (TAVI).
Objective The aim of this study was to examine the intraoperative 2-dimensional (2D) and 3-dimensional (3D) echocardiographic features of the aortic valve associated with significant post-procedural paravalvular AR.
Methods A total of 135 patients (81±7 years) with severe symptomatic aortic stenosis, who underwent TAVI, were imaged with comprehensive 2D and 3D transoesophageal echocardiography before the procedure and peri-procedure. Various baseline and peri-procedural echocardiographic characteristics were tested to predict paravalvular AR post-TAVI: calcifications at the aortic valve commissures and leaflets, ‘aortic annulus eccentricity index’, ‘area cover index’, overlap between aortic prosthesis and anterior mitral leaflet. Post-procedural paravalvular AR≥2 was considered significant.
Results Successful TAVI was achieved in all patients. The incidence of paravalvular AR≥2 immediately after the procedure was 21% (28 patients). Commissural calcifications and, particularly, the calcification of the commissure between the right coronary and non-coronary cusps was significantly more frequent in presence of paravalvular AR; the area cover index pre-TAVI was significantly lower among patients with AR (11.1±11.8% vs 20.8±12.5%, p=0.0004). Multivariate analysis revealed that calcification of the commissure between the right coronary and non-coronary cusps (OR=2.66, 95% CI 1.39 to 5.12, p=0.001), and the area cover index pre-TAVI (OR=0.95, 95% CI 0.91 to 0.99, p=0.006) were the only independent predictors of significant paravalvular AR after TAVI.
Conclusions Intraoperative 2D and 3D transoesophageal echocardiography identified calcification of the commissure between the right coronary and non-coronary cusps and the area cover index as independent predictors of significant paravalvular AR following TAVI.
- Transcatheter aortic valve implantation
- aortic regurgitation
- echocardiography
- valvular disease
- imaging and diagnostics
- MRI
- 3-dimensional
- aortic valve disease
- interventional cardiology
- non-coronary intervention
- percutaneous valve therapy
- cardiac function
- echocardiography–paediatrics
- mitral valve
- aorta
- great vessels and trauma
- arrhythmias
- arrhythmic right ventricular dyplasia
- invasive electrophysiology
- rhythms
- radiofrequency catheter ablation
- cardiomyopathy
- diagnostic imaging
- echocardiography (three-dimensional)
- chronic heart failure
- RV function
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- Transcatheter aortic valve implantation
- aortic regurgitation
- echocardiography
- valvular disease
- imaging and diagnostics
- MRI
- 3-dimensional
- aortic valve disease
- interventional cardiology
- non-coronary intervention
- percutaneous valve therapy
- cardiac function
- echocardiography–paediatrics
- mitral valve
- aorta
- great vessels and trauma
- arrhythmias
- arrhythmic right ventricular dyplasia
- invasive electrophysiology
- rhythms
- radiofrequency catheter ablation
- cardiomyopathy
- diagnostic imaging
- echocardiography (three-dimensional)
- chronic heart failure
- RV function
Footnotes
Funding SHE is financially supported by the Ministry of Health Training Scholarship, Singapore. VD receives consultancy fees from St Jude Medical. The Department of Cardiology of Leiden University Medical Center receives research grant from Edwards Lifesciences, St Jude Medical, Biotronik, Medtronic, Boston Scientific, Lantheus Medical Imaging, St Jude Medical and GE Healthcare.
Competing interests None to declare.
Ethics approval A written consent to the study was obtained from each participant. The adopted protocol did not differ from the standard clinical protocols of each involved institution.
Provenance and peer review Not commissioned; internally peer reviewed.