Transthoracic echocardiography is adequate for intraprocedural assessment of transcatheter aortic valve replacement: P1-118
Jain R, O'Hair D, Bajwa, TK, Kirby A., Harland D, Ignatowski D, Khandheria BK. Transthoracic Echocardiography is Adequate for Intraprocedural Assessment of Transcatheter Aortic Valve Replacement: P1-118. Journal of the American Society of Echocardiography, 2017;30(6), B51-B52.
Poster presented at: 2017 ASE 27th Annual Scientific Sessions, June 2-6, 2017; Baltimore, MD.
Background: While transcatheter aortic valve replacement (TAVR) has been supported traditionally intraprocedurally by transesophageal echocardiography (TEE), there is increasing use of transthoracic echocardiography (TTE). We evaluated echocardiographic quality and outcomes in patients who underwent TTE during TAVR.
Methods: A team of dedicated sonographers and interventional echocardiographers performed TTE during TAVR. TTE was obtained immediately pre-procedure in the cardiac catheterization laboratory with the patient sedated and in the supine position. TTE was performed post-deployment of TAVR to assess for valve structure, function and other complications of TAVR.
Results: TTE TAVR was performed in 237 patients; clinical characteristics are described in the Table. All patients underwent TAVR through transfemoral access, the majority with self-expandable valve (n=236, 99.5%). In the procedure, TTE image quality was excellent in 7 (3.0%) cases, adequate in 203(85.6%), and poor in 27 (11.4%). Parasternal images were adequate in 230 (97%) cases and apical images were adequate in 210 (88.6%). Stent depth was visualized adequately in 230 (97%) cases, and stent shape adequately in 224 (94.9%). Color flow Doppler was adequate in 234 cases (98.7%) - paravalvular regurgitation (PVL) could not be assessed in only 3 cases. Leaflets were visualized in 48 (20%) cases. Both TTE and invasive hemodynamics were used to assess need for post-deployment stent ballooning (n=33, 14.0%). No case required conversion to TEE. TTE adequately recognized new pericardial effusion in 3 cases. TTE recognized deep implant of TAVR stent with severe transvalvular aortic regurgitation, necessitating second TAVR with resolution of transvalvular regurgitation. Compared to TTE performed 24-hours post-TAVR and at 30-day follow-up, there was no case of intraprocedural TTE failing to recognize moderate PVL.
Conclusion: TTE during the TAVR procedure adequately conveyed information on TAVR depth, shape of stent and PVL severity. While leaflets could not be visualized in the majority of cases, the presence of leaflet abnormality could be inferred from transvalvular regurgitation. Dedicated TTE is adequate intraprocedurally when performed by a dedicated team in a highly experienced TAVR center.