Abstract
BackgroundOur 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.MethodsPart 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.ResultsThe 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.ConclusionsAlthough 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.
Highlights
Transcatheter aortic valve replacement (TAVR) has become the treatment of choice for severe aortic diseases
The US Food and Drug Administration has recently approved the use of the self-expanding valve Evolut R and Evolut PRO systems (Medtronic Inc., Minneapolis, MN, USA) and the balloon-expandable valve Sapien 3 (Edwards Lifesciences Inc., Irvine, CA, USA) for the treatment of severe aortic stenosis (AS) in patients at low risk based on the results of large-sample, multicenter randomized controlled trials [3, 4], which is a milestone for the development of this technology
Because direct visualization of the aortic root is not possible during the transcatheter aortic valve replacement (TAVR) procedure, accurate preoperative evaluation of the aortic root is of critical importance to reduce the occurrence of complications such as paravalvular aortic regurgitation (AR), valve embolization, coronary obstruction, atrioventricular block, and annulus rupture
Summary
Transcatheter aortic valve replacement (TAVR) has become the treatment of choice for severe aortic diseases. The US Food and Drug Administration has recently approved the use of the self-expanding valve Evolut R and Evolut PRO systems (Medtronic Inc., Minneapolis, MN, USA) and the balloon-expandable valve Sapien 3 (Edwards Lifesciences Inc., Irvine, CA, USA) for the treatment of severe aortic stenosis (AS) in patients at low risk based on the results of large-sample, multicenter randomized controlled trials [3, 4], which is a milestone for the development of this technology. Our goal was to determine the accuracy of 3-dimensional transesophageal echocardiography (3DTEE) 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 investigated the influence of aortic root calcification on the accuracy of 3D-TEE in aortic annulus evaluations
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