Assessment of Post-Procedural Aortic Regurgitation After TAVR An Intraprocedural TEE Study

作者：Mihara Hirotsugu; Shibayama Kentaro; Jilaihawi Hasan; Itabashi Yuji; Berdejo Javier; Utsunomiya Hiroto; Siegel Robert J; Makkar Raj R; Shiota Takahiro^*

来源：JACC: Cardiovascular Imaging , 2015, 8(9): 993-1003.

DOI：10.1016/j.jcmg.2015.02.029

• aortic stenosis
• paravalvular regurgitation
• transcatheter aortic valve replacement
• transesophageal echocardiography

OBJECTIVES The purpose of this study was to determine which echocardiographic parameters, including holodiastolic flow reversal (HOER) in the descending aorta, were useful for grading of post-procedural aortic regurgitation (PAR) after transcatheter aortic valve replacement (TAVR) using intraprocedural transesophageal echocardiography.
BACKGROUND Reliable assessment of PAR in a catheterization laboratory is essential for an optimal outcome after TAVR; however, such an assessment has not been determined.
METHODS Three hundred eighty patients who underwent TAVR with the Edwards (Irvine, California) balloon-expandable transcatheter heart valve were retrospectively assessed by intraprocedural transesophageal echocardiography. PAR was evaluated by 2-dimensional color Doppler and pulse-wave Doppler in the descending aorta. Using 2-dimensional color Doppler, we measured the cross-sectional area of the vena contracta, the circumferential extent at the aortic annular plane, the Longitudinal jet Length, and the jet extent (with a mosaic pattern in the left ventricular outflow tract) compared with the Location of the tip of the anterior mitral Leaflet (AML). Grading of PAR was determined using the following vena contracta cutoffs: mild <= 9 mm(2); moderate 10 to 29 mm(2); and severe >= 30 mm(2). Significant PAR was defined as at Least moderate grade.
RESULTS All patients with consistent HOER had significant PAR. By multivariable analysis, consistent HDER and the jet extent beyond the tip of AML were independent predictors of significant PAR. Consistent HDFR and jet extent beyond the tip of AML predicted significant PAR with specificities of 100% and 97%, respectively. In contrast, patients with both negative HDFR and a jet extent of less than halfway to the tip of AML had no significant PAR, with 97% specificity.
CONCLUSIONS The presence of consistent HOER and jet extent beyond the tip of AML are indicative of significant PAR after TAVR.

• 出版日期2015-9