Paravalvular Regurgitation after Transcatheter Aortic Valve Replacement: Comparing Transthoracic versus Transesophageal Echocardiographic Guidance

Salim S. Hayek, Frank E. Corrigan, Jose F. Condado, Shuang Lin, Sharon Howell, James P. MacNamara, Shuai Zheng, Patricia Keegan, Vinod Thourani, Vasilis C. Babaliaros, Stamatios Lerakis

Research output: Contribution to journalArticlepeer-review

29 Scopus citations

Abstract

Background Transcatheter aortic valve replacement (TAVR) is increasingly being performed in cardiac catheterization laboratories using transthoracic echocardiography (TTE) to guide valve deployment. The risk of paravalvular regurgitation (PVR) remains a concern. Methods We retrospectively reviewed 454 consecutive patients (mean age, 82 ± 8; 58% male) who underwent transfemoral TAVR at Emory Healthcare from 2007 to 2014. Two hundred thirty-four patients underwent TAVR in the cardiac catheterization laboratory with TTE guidance (TTE-TAVR; mean Society of Thoracic Surgeons score, 10%), while 220 patients underwent the procedure in the hybrid operating room with transesophageal echocardiography (TEE) guidance (TEE-TAVR; mean Society of Thoracic Surgeons score, 11%). All patients received an Edwards valve (SAPIEN 55%, SAPIEN-XT 45%). Clinical and procedural characteristics, echocardiographic parameters, and incidence of PVR were compared. Results The incidence of at least mild PVR at discharge was comparable between TTE-TAVR and TEE-TAVR (33% vs 38%, respectively; P =.326) and did not differ when stratified by valve type. However, in the TTE-TAVR group, there was a higher incidence of second valve implantation (7% vs 2%; P =.026) and postdilation (38% vs 17%; P <.001) during the procedure. Although not independently associated with PVR at discharge (odds ratio = 1.12; 95% CI, 0.69–1.79), TTE-TAVR was associated with PVR-related events: the combined outcome of mild PVR at discharge, intraprocedural postdilation, and second valve insertion (odds ratio = 1.58; 95% CI, 1.01–2.46). There were no significant differences in PVR at 30 days, 6 months, and 1 year between the two groups. Conclusions TTE-TAVR in a high-risk group of patients was associated with increased incidence of intraprocedure PVR-related events, although it was not associated with higher rates of PVR at follow-up. Multicenter randomized trials are required to confirm the cost-effectiveness and safety of TTE-TAVR.

Original languageEnglish (US)
Pages (from-to)533-540
Number of pages8
JournalJournal of the American Society of Echocardiography
Volume30
Issue number6
DOIs
StatePublished - Jun 2017
Externally publishedYes

Keywords

  • Minimalist
  • Paravalvular regurgitation
  • Transcatheter aortic valve replacement
  • Transesophageal echocardiography

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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