Elsevier

JACC: Cardiovascular Imaging

Volume 4, Issue 10, October 2011, Pages 1053-1062
JACC: Cardiovascular Imaging

Original Research
Validation and Characterization of Transcatheter Aortic Valve Effective Orifice Area Measured by Doppler Echocardiography

https://doi.org/10.1016/j.jcmg.2011.06.021Get rights and content
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Objectives

The objectives were to compare different Doppler echocardiographic methods for the measurement of prosthetic valve effective orifice area (EOA) following transcatheter aortic valve implantation (TAVI) and to determine the factors influencing the EOA of transcatheter balloon expandable valves.

Background

Previous studies have used different methods for the measurement of the valve EOA following TAVI. Factors influencing the EOA of transcatheter valves are unknown.

Methods

A total of 122 patients underwent TAVI with the use of the Edwards-SAPIEN valve (Edwards Lifesciences, Irvine, California). The EOA was measured by transthoracic echocardiography at hospital discharge, 6 months and 1 year after TAVI with the use of 2 methods as described in previous studies. In Method #1 (EOA1), LVOT diameter (LVOTd) entered in the continuity equation was measured at the base of prosthesis cusps whereas, in Method #2 (EOA2), LVOTd was measured immediately proximal to the prosthesis stent.

Results

The average EOA2 (1.57 ± 0.41 cm2) was larger (p < 0.01) than the EOA1 (1.21 ± 0.38 cm2). Accordingly, incidence of severe PPM (indexed EOA ≤0.65 cm2/m2) was 3-fold lower with the use of EOA2 than with EOA1 (9% vs. 33%; p < 0.001). Mean transprosthetic gradient correlated better (p = 0.03) with indexed EOA2 (r = −0.70, p < 0.0001) than with indexed EOA1 (r = −0.58, p < 0.0001). Intraobserver and interobserver variability were lower for EOA2 compared to EOA1 (intra: 5% vs. 7%, p = 0.06; inter: 6% vs. 14%; p < 0.001). Aortic annulus size was the sole independent determinant (p = 0.01) of prosthetic valve EOA2. The average EOA varied from 1.37 ± 0.23 cm2 for aortic annulus size <19 mm up to 1.90 ± 0.17 cm2 for size >23 mm.

Conclusions

When estimating the EOA of Edwards-SAPIEN valves by Doppler-echocardiography, it is recommended to use the LVOT diameter and velocity measured immediately proximal to the stent. The main determinant of the EOA of transcatheter valves is the patient's annulus size and these valves provide excellent hemodynamics even in patients with a small aortic annulus.

Key Words

aortic stenosis
echocardiography
prosthesis
transcatheter
valves

Abbreviations and Acronyms

AVR
aortic valve replacement
ELC
energy loss coefficient
EOA
aortic valve effective orifice
LV
left ventricle/ventricular
LVOT
left ventricular outflow tract
PPM
prosthesis–patient mismatch
TAVI
transcatheter aortic valve implantation
TEE
transesophageal echocardiography/echocardiographic

Cited by (0)

Dr. Clavel holds a Vanier Canada Graduate Scholarship, Canadian Institutes of Health Research, Ottawa, Ontario, Canada. Drs. Rodés-Cabau, Dumont, and Doyle hold consultancies and/or are on the speaker's bureau of Edwards Lifesciences and/or they have received research grants from this company. Dr. Rodés-Cabau is a consultant for St. Jude Medical. Dr. Pibarot holds the Canada Research Chair in Valvular Heart Disease, Canadian Institutes of Health Research, Ottawa, Ontario, Canada. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.