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

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• 作者：Kentaro Shibayama ; MD<sup>asup><sup> ; sup><sup>bsup> ; Hirotsugu Mihara ; MD<sup>asup> ; Hasan Jilaihawi ; MD<sup>asup> ; Javier Berdejo ; MD<sup>asup> ; Kenji Harada ; MD<sup>asup> ; Yuji Itabashi ; MD<sup>asup> ; Robert Siegel ; MD<sup>asup><sup> ; sup><sup>csup> ; Raj R. Makkar ; MD<sup>asup> ; Takahiro Shiota ; MD<sup>asup><sup> ; sup><sup>csup><sup> ; sup><sup>ShiotaT@cshs.org" class="auth_mail" title="E-mail the corresponding authorsup>
• 关键词：aortic valve ; aortic valve insufficiency ; echocardiography
• 刊名：JACC: Cardiovascular Imaging
• 出版年：2016
• 出版时间：February 2016
• 年：2016
• 卷：9
• 期：2
• 页码：114-123
• 全文大小：1426 K

文摘

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.

sSec_2">Background

spara0015">The mechanism of AR after TAVR, particularly that of transvalvular AR, has not been evaluated adequately.

sSec_3">Methods

spara0020">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.

sSec_4">Results

spara0025">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.

sSec_5">Conclusions

spara0030">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.