Abstract
(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.
Highlights
IntroductionAccurate sizing of the aortic annulus is a crucial step towards the success of Transcatheter aortic valve replacement (TAVR) and is the preferred source of the transcatheter heart valve (THV) selection [8,9,10,11]
Transcatheter aortic valve replacement (TAVR) has evolved as a safe and effective intervention alternative to surgical aortic valve replacement (SAVR), allowing high-risk, intermediate-risk, and recently low-surgical risk patients to be treated for severe symptomatic aortic stenosis (AS) by replacing the native valve with a bioprosthetic valve [1,2,3,4,5,6,7].Accurate sizing of the aortic annulus is a crucial step towards the success of TAVR and is the preferred source of the transcatheter heart valve (THV) selection [8,9,10,11]
Studies were considered eligible in the meta-analysis if they met the following criteria: (1) studies which included patients with symptomatic aortic stenosis or/and underwent TAVR for aortic valve replacement; (2) studies evaluating the aortic annulus measurements by automated or semiautomated 3D-TEE as an index test and multidetector computed tomography (MDCT) as a reference standard; (3) studies which assessed the correlation coefficient or agreement between the finding of MDCT and 3D-TEE for aortic annular measurements; and (4 ) original published articles as type of study
Summary
Accurate sizing of the aortic annulus is a crucial step towards the success of TAVR and is the preferred source of the transcatheter heart valve (THV) selection [8,9,10,11]. A multidetector computed tomography (MDCT) procedure for pre-TAVR planning has been recommended to be the gold standard method due to the ability to accurately measure the dimensions of the ascending aorta, the aortic root, and the aortic annulus (AA) [16,17,18,19]. Three-dimensional transesophageal echocardiography (3D-TEE), which does not require iodinated contrast, may be a useful imaging tool during TAVR, providing accurate measurements of the aortic root and geometry as an alternative to MDCT [23,24,25,26,27]
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