BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an alternative therapy for high-risk patients with symptomatic aortic stenosis. TAVI without balloon aortic predilation (BPD) has been found to be as feasible and safe as the standard approach with predilation. The aim of this study was to show the usefulness of transesophageal echocardiographic (TEE) criteria during patient selection for TAVI without BPD and compare the results with those from a control group. METHODS: Two hundred forty-nine consecutive patients with severe symptomatic aortic stenosis underwent echocardiographic evaluation before TAVI. Two-dimensional and three-dimensional TEE imaging was used to evaluate the aortic annulus and root, leaflet mobility and degree of calcification, orifice characteristics, valve area, and aortic regurgitation. After TEE data were reviewed, patients were considered to be favorable candidates, or not, for TAVI without BPD on the basis of specific echocardiographic criteria. RESULTS: The mean age was 82 ± 5 years. Seventy-nine patients underwent TAVI without BPD, and 170 patients underwent TAVI with BPD. The mean aortic valve area was 0.61 ± 0.16 cm(2), and the mean aortic annular diameter was 2.2 ± 0.25 cm. In the group without BPD, Edwards SAPIEN XT valves were implanted in 64.6% (n = 51) and Medtronic CoreValve prostheses in 35.4% (n = 28). In this group, residual paravalvular aortic regurgitation immediately after valve deployment was seen in 53.2% of patients, without differences from those who underwent TAVI with BPD. Permanent pacemaker implantation was less frequent in the group of patients without BPD (6.3% vs 14.1%, P = .030). Procedure-related mortality was significantly lower in patients without BPD (2.5% vs 11.8%, P = .018). CONCLUSIONS: Thorough TEE assessment of aortic valve features permits the selection of patients with ideal conditions for TAVI without BPD, regardless of the type of prosthesis. Using the echocardiographic criteria described here, it is possible to achieve a good rate of procedural success with a low complication rate in patients undergoing TAVI without BPD.
BACKGROUND: Transcatheter aortic valve implantation (TAVI) is an alternative therapy for high-risk patients with symptomatic aortic stenosis. TAVI without balloon aortic predilation (BPD) has been found to be as feasible and safe as the standard approach with predilation. The aim of this study was to show the usefulness of transesophageal echocardiographic (TEE) criteria during patient selection for TAVI without BPD and compare the results with those from a control group. METHODS: Two hundred forty-nine consecutive patients with severe symptomatic aortic stenosis underwent echocardiographic evaluation before TAVI. Two-dimensional and three-dimensional TEE imaging was used to evaluate the aortic annulus and root, leaflet mobility and degree of calcification, orifice characteristics, valve area, and aortic regurgitation. After TEE data were reviewed, patients were considered to be favorable candidates, or not, for TAVI without BPD on the basis of specific echocardiographic criteria. RESULTS: The mean age was 82 ± 5 years. Seventy-nine patients underwent TAVI without BPD, and 170 patients underwent TAVI with BPD. The mean aortic valve area was 0.61 ± 0.16 cm(2), and the mean aortic annular diameter was 2.2 ± 0.25 cm. In the group without BPD, Edwards SAPIEN XT valves were implanted in 64.6% (n = 51) and Medtronic CoreValve prostheses in 35.4% (n = 28). In this group, residual paravalvular aortic regurgitation immediately after valve deployment was seen in 53.2% of patients, without differences from those who underwent TAVI with BPD. Permanent pacemaker implantation was less frequent in the group of patients without BPD (6.3% vs 14.1%, P = .030). Procedure-related mortality was significantly lower in patients without BPD (2.5% vs 11.8%, P = .018). CONCLUSIONS: Thorough TEE assessment of aortic valve features permits the selection of patients with ideal conditions for TAVI without BPD, regardless of the type of prosthesis. Using the echocardiographic criteria described here, it is possible to achieve a good rate of procedural success with a low complication rate in patients undergoing TAVI without BPD.
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Authors: Rodrigo Bagur; Chun Shing Kwok; Luis Nombela-Franco; Peter F Ludman; Mark A de Belder; Sandro Sponga; Mark Gunning; James Nolan; Pantelis Diamantouros; Patrick J Teefy; Bob Kiaii; Michael W A Chu; Mamas A Mamas Journal: J Am Heart Assoc Date: 2016-06-13 Impact factor: 5.501
Authors: Christian Butter; Peter Bramlage; Tanja Rudolph; Claudius Jacobshagen; Jürgen Rothe; Hendrik Treede; Sebastian Kerber; Derk Frank; Lenka Seilerova; Gerhard Schymik Journal: BMC Cardiovasc Disord Date: 2016-11-15 Impact factor: 2.298
Authors: Gerhard Schymik; Tanja Rudolph; Claudius Jacobshagen; Jürgen Rothe; Hendrik Treede; Sebastian Kerber; Derk Frank; Lenka Sykorova; Maki Okamoto; Martin Thoenes; Cornelia Deutsch; Peter Bramlage; Christian Butter Journal: Open Heart Date: 2019-10-03