AS-62: The First Saudi Experience of the Role of Transesophageal Echocardiography in Transcatheter Aortic Valve Replacement

(1) Background: We performed this study to evaluate the agreement between novel automated software of three-dimensional transesophageal echocardiography (3D-TEE) and multidetector computed tomography (MDCT) for aortic annular measurements of preprocedural transcatheter aortic valve replacement (TAVR); (2) Methods: PubMed, EMBASE, Web of Science, and Cochrane Library (Wiley) databases were systematically searched for studies that compared 3D-TEE and MDCT as the reference standard for aortic annular measurement of the following parameters: annular area, annular perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter. Meta-analytic methods were utilized to determine the pooled correlations and mean differences between 3D-TEE and MDCT. Heterogeneity and publication bias were also assessed. Meta-regression analyses were performed based on the potential factors affecting the correlation of aortic annular area; (3) Results: A total of 889 patients from 10 studies were included in the meta-analysis. Pooled correlation coefficients between 3D-TEE and MDCT of annulus area, perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter measurements were strong 0.89 (95% CI: 0.84–0.92), 0.88 (95% CI: 0.83–0.92), 0.87 (95% CI: 0.77–0.93), 0.87 (95% CI: 0.77–0.93), 0.79 (95% CI: 0.64–0.87), and 0.75 (95% CI: 0.61–0.84) (Overall p < 0.0001), respectively. Pooled mean differences between 3D-TEE and MDCT of annulus area, perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter measurements were −20.01 mm2 ((95% CI: −35.37 to −0.64), p = 0.011), −2.31 mm ((95% CI: −3.31 to −1.31), p < 0.0001), −0.22 mm ((95% CI: −0.73 to 0.29), p = 0.40), −0.47 mm ((95% CI: −1.06 to 0.12), p = 0.12), −1.36 mm ((95% CI: −2.43 to −0.30), p = 0.012), and 0.31 mm ((95% CI: −0.15 to 0.77), p = 0.18), respectively. There were no statistically significant associations with the baseline patient characteristics of sex, age, left ventricular ejection fraction, mean transaortic gradient, and aortic valve area to the correlation between 3D-TEE and MDCT for aortic annular area sizing; (4) Conclusions: The present study implies that 3D-TEE using novel software tools, automatically analysis, is feasible to MDCT for annulus sizing in clinical practice.

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3D TRANSESOPHAGEAL ECHOCARDIOGRAPHY FOR GUIDING TRANSCATHETER AORTIC VALVE REPLACEMENT WITHOUT PRIOR CARDIAC COMPUTED TOMOGRAPHY IN PATIENTS WITH RENAL DYSFUNCTION

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(21)02531-6 ◽

2021 ◽

Vol 77 (18) ◽

pp. 1172

Author(s):

Paulina Skaff ◽

Karthik Seetharam ◽

Samian Suleiman ◽

Bryan Raybuck ◽

Mohammad Akram Kawsara ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Transesophageal Echocardiography ◽

Renal Dysfunction ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Cardiac Computed Tomography ◽

Transcatheter Aortic Valve ◽

3D Transesophageal Echocardiography

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Abstract 12320: Assessment of Post-Procedural Aortic Regurgitation After Transcatheter Aortic Valve Replacement During the Procedure: An Intraprocedural Transesophageal Echocardiography Study

Circulation ◽

10.1161/circ.130.suppl_2.12320 ◽

2014 ◽

Vol 130 (suppl_2) ◽

Author(s):

Hirotsugu Mihara ◽

Kentaro Shibayama ◽

Hasan Jilaihawi ◽

Yuji Itabashi ◽

Javier Berdejo ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Transesophageal Echocardiography ◽

Aortic Regurgitation ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Color Doppler ◽

Descending Aorta ◽

Transcatheter Aortic Valve ◽

Pulsed Wave Doppler

Introduction: The assessment of post-procedual aortic regurgitation (PAR) after transcatheter aortic valve replacement (TAVR) has not been validated. The purpose of this study was (1) to investigate the value of holodiastolic flow reversal (HDFR) in the descending aorta in patients with PAR after TAVR and (2) to determine which color Doppler parameters are useful for PAR grading using the intraprocedural transesophageal echocardiography (iTEE). Hypothesis: We hypothesized that HDFR in the descending aorta and any color Doppler parameters can delineate significant PAR after TAVR. Methods: Three hundred-eighty patients with severe aortic stenosis underwent TAVR with the Edwards SAPIEN valve with 131 pulsed-wave Doppler tracings from the descending aorta had assessed by iTEE. PAR was evaluated using 2D color Doppler by the cross-sectional area of the vena contracta (VCA) at the aortic annular plane, and by the longitudinal jet extent (mosaic signals, Figure A) compared to the location of the tip of the anterior mitral leaflet (AML). Significant PAR was defined as VCA of ≥10 mm2, corresponding to greater than a moderate grade. Results: In patients with any grade of PAR, pulsed-wave Doppler tracing from the descending aorta, jet extent and VCA were obtained in 100%, 80%, and 74%, respectively. All patients with consistent HDFR had significant PAR. By multivariate analysis, a consistent HDFR and jet extent beyond the tip of AML were independent predictors of significant PAR. A consistent HDFR and jet extent beyond the tip of AML predicted significant PAR with specificity of 100% and 97%, respectively. In the other hand, patients with both negative HDFR and jet extent of less than halfway to the tip of AML had no significant PAR with a 97% specificity. Conclusions: The presence of HDFR with each cardiac cycle and jet extent beyond the tip of AML are indicative of significant PAR.

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