Feasibility of a new method using two-dimensional transesophageal echocardiography for aortic annular sizing in patients undergoing transcatheter aortic valve implantation; a case-control study.

Mohammad Sherif ,Christian Praast,Georg Ertl,Octavian Maniuc,Wolfram Voelker,Joerg Herold,Ruediger C Braun‐Dullaeus

doi:10.1186/s12872-015-0072-7

Abstract

BackgroundAccurate preoperative assessment of the aortic annulus dimension is crucial for successful transcatheter aortic valve implantation (TAVI). In this study we validated a new method using two-dimensional transesophageal echocardiography (2D-TEE) for measurement of the aortic annulus prior to TAVI.MethodsWe analysed 124 patients who underwent successful TAVI using a self-expandable prosthesis, divided equally into two groups; in the study group we used the cross sectional short axis 2D-TEE for measurement of the aortic annulus and in the control group we used the long axis 2D-TEE.ResultsBoth groups were comparable regarding the clinical parameters. On the other hand, patients in the study group had less left ventricular ejection fraction (38.9 % versus 45.6 %, p = 0.01). The aortic valve annulus was, although not statistically significant, smaller in the study group (21.58 versus 23.28 mm, p = 0.25).Post procedural quantification of the aortic regurgitation revealed that only one patient in both groups had severe aortic regurgitation (AR), in this patient the valve was implanted deep. The incidence of significant AR was higher in the control group (29.0 % versus 12.9 %, p = 0.027).ConclusionsSizing of the aortic valve annulus using cross-sectional 2D-TEE offers a safe and plausible method for patients undergoing TAVI using the self-expandable prosthesis and is significantly superior to using long axis 2D-TEE.

Highlights

Accurate preoperative assessment of the aortic annulus dimension is crucial for successful transcatheter aortic valve implantation (TAVI)
In this study we examined a new method using Two-dimensional transesophageal echocardiography (2D-transesophageal echocardiography (TEE)) for non-invasive preoperative evaluation of the aortic annulus prior to TAVI using Medtronic CoreValve bioprosthesis
There were no cases of aortic annulus rupture, aortic dissection, coronary ostia occlusion, or prosthesis migration

Summary

Methods

Study design and patients One hundred and twenty-four patients with severe symptomatic AS (AVA < 1 cm or AVA indexed to body surface area < 0.6 cm2/m2) were included in this study. Annular size measurement was performed using the enlarged view of the midoesophageal long axis (Approximately 110° to 140°, referred to as the “3-chamber view”) during the early systolic phase of the cardiac cycle In this projection, the left ventricular chamber, outflow tract, and ascending aorta should be aligned along their long axes to ensure that the sagittal plane bisects the maximal diameter of the annulus. The multiplane angle was rotated forward to approximately 30 to 60° until a symmetrical image of all three cusps of the aortic valve and the coronary sinuses comes into view This view shows how the leaflets join together along trifoliate zones of apposition extending from peripheral attachments at the sinutubular junction to the centroid of the valvar orifice. The mean values and proportions of baseline variables were

Results

Background

Discussion

Limitations