Clinical Research
Interventional Cardiology
Aortic Annular Sizing for Transcatheter Aortic Valve Replacement Using Cross-Sectional 3-Dimensional Transesophageal Echocardiography

https://doi.org/10.1016/j.jacc.2012.11.055Get rights and content
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Objectives

This study compared cross-sectional three-dimensional (3D) transesophageal echocardiography (TEE) to two-dimensional (2D) TEE as methods for predicting aortic regurgitation after transcatheter aortic valve replacement (TAVR).

Background

Data have shown that TAVR sizing using cross-sectional contrast computed tomography (CT) parameters is superior to 2D-TEE for the prediction of paravalvular aortic regurgitation (AR). Three-dimensional TEE can offer cross-sectional assessment of the aortic annulus but its role for TAVR sizing has been poorly elucidated.

Methods

All patients had severe symptomatic aortic stenosis and were treated with balloon-expandable TAVR in a single center. Patients studied had both 2D-TEE and 3D imaging (contrast CT and/or 3D-TEE) of the aortic annulus at baseline. Receiver-operating characteristic curves were generated for each measurement parameter using post-TAVR paravalvular AR moderate or greater as the state variable.

Results

For the 256 patients studied, paravalvular AR moderate or greater occurred in 26 of 256 (10.2%) of patients. Prospectively recorded 2D-TEE measurements had a low discriminatory value (area under the curve = 0.52, 95% confidence interval: 0.40 to 0.63, p = 0.75). Average cross-sectional diameter by CT offered a high degree of discrimination (area under the curve = 0.82, 95% confidence interval: 0.73 to 0.90, p < 0.0001) and mean cross-sectional diameter by 3D-TEE was of intermediate value (area under the curve = 0.68, 95% confidence interval: 0.54 to 0.81, p = 0.036).

Conclusions

Cross-sectional 3D echocardiographic sizing of the aortic annulus dimension offers discrimination of post-TAVR paravalvular AR that is significantly superior to that of 2D-TEE. Cross-sectional data should be sought from 3D-TEE if good CT data are unavailable for TAVR sizing.

Key Words

computed tomography
paravalvular aortic regurgitation
3D echocardiography
transcatheter aortic valve implantation
transcatheter aortic valve replacement

Abbreviations and Acronyms

AR
aortic regurgitation
CI
confidence interval
CT
computed tomography
LVEF
left ventricular ejection fraction
OR
odds ratio
PAVR
paravalvular aortic regurgitation
ROC
receiver-operating characteristic
TAVR
transcatheter aortic valve replacement
TEE
transesophageal echocardiography
TTE
transthoracic echocardiography
2D
two-dimensional
3D
three-dimensional

Cited by (0)

Dr. Jilaihawi is a consultant for Edwards Lifesciences, St. Jude Medical, and Venus Medtech. Dr. Siegel is a consultant to Abbott and speaker for Philips Ultrasound. Dr. Gurudevan in on the Speakers' Bureau for Lantheus Medical Imaging. Dr. Fontana has relationships with St. Jude Medical, Edwards Lifesciences, Medtronic, and Entourage Medical Technologies; and equity in Entourage Medical Technologies. Dr. Makkar receives research grants from Edwards, Medtronic, Abbott, Capricor, and St. Jude Medical; and is a proctor for Edwards and consultant to Medtronic. All other authors have reported they have no relationships relevant to the contents of this paper to disclose.