scholarly journals Application of three-dimensional transesophageal echocardiography in preoperative evaluation of transcatheter aortic valve replacement

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Peng Ding ◽  
Chennian Xu ◽  
Yang Liu ◽  
Xin Meng ◽  
Ping Jin ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Linear Regression ◽  
Aortic Valve Replacement ◽  
Aortic Root ◽  
Transcatheter Aortic Valve Replacement ◽  
Preoperative Evaluation ◽  
Rank Correlation ◽  
Spearman Rank Correlation ◽  
Spearman Rank ◽  
Transcatheter Aortic Valve

Abstract Background Our goal was to determine the accuracy of 3-dimensional transesophageal echocardiography (3D-TEE) compared with that of computed tomography (CT) in the preoperative evaluation for transcatheter aortic valve replacement (TAVR) when the errors caused by inconsistent software and method have been eliminated and the representativeness of the sample has been improved. We also investigated the influence of aortic root calcification on the accuracy of 3D-TEE in aortic annulus evaluations. Methods Part I: 45 of 233 patients who underwent TAVR in the department of cardiovascular surgery at the Xijing hospital from January 2016 to August 2019 were studied retrospectively. Materialise Mimics software and the multiplanar reconstruction method were used for evaluation, based on 3D-TEE and CT. The annulus area-derived diameter, the annulus perimeter-derived diameter (Dp), the annulus mean diameter, the left ventricular outflow tract Dp diameter, the sinotubular junction (STJ) diameter-Dp, and the aortic sinus diameter were compared and analyzed. Part II: 31 of 233 patients whose 3D-TEE and CT data were well preserved and in the required format were included. HU450 and HU850 were used as indicators to measure the severity of calcification. The Spearman rank correlation and Linear regression were used to analyze the correlation between aortic root calcification and the accuracy of 3D-TEE in aortic annulus measurement. Results The measurement results based on 3D-TEE were significantly lower than those obtained using CT (P < 0.05), except for the STJ diameter-Dp in diastole (P = 0.11). The correlation coefficient of the two groups was 0.699–0.954 (P < 0.01), which also indicated a significant correlation between the two groups. A Bland–Altman plot showed that the ordinate values were mostly within the 95% consistency limit; the consistency of the two groups was good. By establishing the linear regression equation, the two groups can be inferred from each other. The Spearman rank correlation analysis and the Linear regression analysis showed that the influence of aortic calcification on the accuracy of the 3D-TEE annulus evaluation was limited. Conclusions Although an evaluation based on 3D-TEE underestimated the results, we can deduce CT results from 3D-TEE because the two methods exhibit considerable correlation and consistency. Trial registration Name: Surgery and Transcatheter Intervention for Structural Heart Diseases. Number: NCT02917980. URL: https://clinicaltrials.gov/ct2/results?term=NCT02917980.

scholarly journals Effect of Eccentric Calcification of an Aortic Valve on the Implant Depth of a Venus-A Prosthesis During Transcatheter Aortic Valve Replacement: A Retrospective Study

2021 ◽  
Vol 12 ◽  
Author(s):  
Lanlan Li ◽  
Yang Liu ◽  
Ping Jin ◽  
Jiayou Tang ◽  
Linhe Lu ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Transcatheter Aortic Valve Replacement ◽  
Ventricular Outflow Tract ◽  
Left Ventricular ◽  
Release Process ◽  
Standard Position ◽  
Transcatheter Aortic Valve

ObjectOur goal was to assess the implant depth of a Venus-A prosthesis during transcatheter aortic valve replacement (TAVR) when the areas of eccentric calcification were distributed in different sections of the aortic valve.MethodsA total of 53 patients with eccentric calcification of the aortic valve who underwent TAVR with a Venus-A prosthesis from January 2018 to November 2019 were retrospectively analyzed. The patients were divided into three groups (A, B, and C) according to the location of the eccentric calcification, which was determined by preprocedural computerized tomography angiography (CTA) images. The prosthesis release process and position were evaluated by contrast aortography during TAVR, and the differences in valve implant depths were compared among the three groups. The effects of different aortic root structures and procedural strategies on prosthesis implant depth were analyzed.ResultsEleven patients had eccentric calcification in region A; 19 patients, in region B; and 23 patients, in region C. The patients with eccentric calcification in region B had a higher risk of prosthesis migration (10.5% upward and 21.1% downward), and the position of the prosthesis after TAVR in group B was the deepest among the three groups. When eccentric calcification was located in region A or C, the prosthesis was released at the standard position with more stability, and the location of the prosthesis was less deep after TAVR (region A: 4.12 ± 3.4 mm; region B: 10.2 ± 5.3 mm; region C: 8.4 ± 4.0 mm; region A vs. region B, P = 0.0004; region C vs. region B; and P = 0.0360). In addition, the left ventricular outflow tract (LVOT) (P = 0.0213) and aortic root angulation (P = 0.0263) also had a significant effect on implant depth in the aortic root structure of the patients. The prosthesis size was 28.3 ± 2.4 in the deep implant group and 26.4 ± 2.0 in the appropriate implant group (P = 0.0068).ConclusionThe implant depth of the Venus-A prosthesis is closely related to the distribution of eccentric calcification in the aortic valve during TAVR. Surgeons should adjust the surgical strategy according to aortic root morphology to prevent prosthesis migration.

scholarly journals Application of Three-Dimensional Transesophageal Echocardiography in Preoperative Evaluation of Transcatheter Aortic Valve Replacement

2020 ◽  
Author(s):  
Peng Ding ◽  
Chennian Xu ◽  
Yang Liu ◽  
Jiayou Tang ◽  
Ping Jin ◽  
...  
Keyword(s):  
Roc Curve ◽  
Aortic Root ◽  
Preoperative Evaluation ◽  
Rank Correlation ◽  
Left Ventricular ◽  
Aortic Annulus ◽  
Spearman Rank Correlation ◽  
Aortic Sinus ◽  
Spearman Rank ◽  
Annulus Diameter

Abstract BackgroundAnalysing the accuracy of 3D-TEE in preoperative evaluation of TAVR compared with CT when the error led by inconsistent software and method has been eliminated and the representativeness of sample has been improved, and exploring the influence of aortic root calcification on the accuracy of 3D-TEE in aortic annulus evaluations.MethodsPart I: 45 of 233 patients who underwent TAVR in the department of cardiovascular surgery in Xijing hospital from January 2016 to August 2019 were retrospectively studied. Mimics and multiplanar reconstruction method were used for evaluation based on 3D-TEE and CT. Annulus diameter - area derived (Da), annulus diameter - perimeter derived (Dp), annulus mean diameter, the left ventricular outflow tract (LVOT) diameter-Dp, the sinus tube junction (STJ) diameter-Dp and aortic sinus diameter were compared and analyzed. Part ii: 31 of 233 patients whose 3D-TEE and CT data were well preserved and in the required format were included. HU450 and HU850 were used as indicators to measure the severity of calcification, and spearman rank correlation and ROC curve was used to analyze the correlation between aortic root calcification and accuracy of 3D-TEE in aortic annulus measurement.ResultsThe measurement results based on 3D-TEE were significantly lower than those of CT (p<0.05), except for the STJ diameter-Dp in diastole (p=0.11). The correlation coefficient of the two groups was 0.699 ~ 0.954 (p < 0.01), which also indicated a significant correlation between the two groups.Bland-Altman plot showed that the ordinate values were mostly within the 95% consistency limit, the consistency of the two groups was good. By establishing the linear regression equation, the two groups can be inferred from each other. Spearman rank correlation analysis and ROC curve analysis showing that the influence of aortic calcification on the accuracy of 3D-TEE annulus evaluation was limited.ConclusionsWhlie evaluation based on 3D-TEE underestimated the results, we can deduce CT results from 3D-TEE as they obtain considerable correlation and consistency. Calcification in the aortic sinus did not affect the accuracy of 3D-TEE annulus evaluation.Trial registrationName: Surgery and Transcatheter Intervention for Structural Heart DiseasesNumber: NCT02917980URL : https://clinicaltrials.gov/ct2/results?term=NCT02917980

scholarly journals Aortic root rupture during balloon-expandable transcatheter aortic valve replacement in a patient without recognized risk factors for aortic root rupture: a case report

2020 ◽  
Vol 4 (3) ◽  
pp. 1-4
Author(s):  
Masaki Tsuda ◽  
Isamu Mizote ◽  
Takashi Mukai ◽  
Yasushi Sakata
Keyword(s):  
Risk Factors ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Aortic Root ◽  
Transcatheter Aortic Valve Replacement ◽  
Transoesophageal Echocardiography ◽  
Additional Risk Factor ◽  
Transfemoral Approach ◽  
Transcatheter Aortic Valve

Abstract Background Aortic root rupture is a severe complication of balloon-expandable transcatheter aortic valve replacement (TAVR). Although previous studies have revealed several risk factors for this complication, predicting this complication is occasionally difficult. Case summary A 78-year-old male patient underwent TAVR via a transfemoral approach using a 29-mm balloon-expandable valve. No recognized risk factors for aortic root rupture existed in pre-procedural multi-detector computed tomography (MDCT) analysis. However, after the valve deployment, sudden haemodynamic collapse occurred. Transoesophageal echocardiography revealed pericardial effusion, which led to an immediate diagnosis of cardiac tamponade following aortic root rupture. Following pericardial drainage via a subxiphoid approach, the haemodynamics were immediately stabilized. After 10 days of close observation, the patient was discharged on Day 39 without additional problems. He was still alive at the 6-month follow-up without sequelae. Discussion Established risk factors for aortic root rupture include &gt;20% area oversizing, bicuspid aortic valve, small annulus (&lt;20 mm), shallow sinus of Valsalva (SOV) compared with the aortic annulus, and massive annular or subannular calcification. Our patient did not have any of the recognized risk factors for aortic root rupture, suggesting the existence of other factors. Pre-procedural MDCT showed a flat calcification orthogonal to the aortic root wall, and post-procedural MDCT revealed that this calcification penetrated the SOV with extravasation. Thus, we suggest that a flat calcification orthogonal to the aortic root wall might be an additional risk factor for aortic root rupture.

Abstract 20549: Patient-Specific CT Image-Based Engineering Analysis of Transcatheter Aortic Valve Replacement - Implications for Aortic Root Rupture

Circulation ◽  
2014 ◽  
Vol 130 (suppl_2) ◽  
Author(s):  
Qian Wang ◽  
Caitlin Martin ◽  
Susheel Kodali ◽  
Jonathon Leipsic ◽  
Philipp Blanke ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Clinical Outcomes ◽  
Valve Replacement ◽  
Aortic Root ◽  
Transcatheter Aortic Valve Replacement ◽  
Aortic Rupture ◽  
Blind Study ◽  
Patient Specific ◽  
Transcatheter Aortic Valve

Introduction: Despite the increased global experience with transcatheter aortic valve replacement (TAVR), there remain major adverse clinical events. One of the most severe complications of TAVR is aortic rupture. Although several clinical risk factors of TAVR-induced rupture have been identified, the mechanisms remain largely unknown. The objective of this study was to use computational models to predict potential aortic rupture in TAVR patients. Methods: Pre-procedural CT scans of TAVR patients were used to reconstruct patient-specific finite element (FE) models, which included the aortic root, aortic leaflets, calcification, mitral-aortic intervalvular fibrosa, anterior mitral leaflet, fibrous trigones, and left ventricle. Stent deployment was simulated in a total of 25 patients to evaluate the potential for aortic rupture. Our research design consisted of two phases: Phase One, which was to develop and calibrate FE modeling techniques by retrospectively analyzing 7 Edwards SAPIEN cases with known results; and Phase Two, which was to implement the modeling methodology developed in Phase One to conduct a blind study of 18 cases from a database of 60 patients consisting of 50% rupture cases. For the blind study, FE simulations were completed by researchers blind to the clinical outcomes, and data analysis was conducted by an independent researcher. Results: Simulations correctly predicted 83% of the rupture cases. The balloon pressure at time of rupture was approximately 3.52 atm and 2.53 atm for SAPIEN 23 and 26 valves, respectively. The average contact force between the stent and native tissue was about 81N. Conclusion: Our analysis of over 18 patients suggested that the TAVR outcome could depend on the patient-specific aortic sinus shape, calcification volume, shape, location, and orientation. These results demonstrate the potential for simulation-based pre-TAVR planning tools to evaluate device performance and improve clinical outcomes.

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