Salim S Hayek1, Frank E Corrigan1, Jose F Condado1, Shuang Lin1, Sharon Howell1, James P MacNamara2, Shuai Zheng3, Patricia Keegan1, Vinod Thourani4, Vasilis C Babaliaros1, Stamatios Lerakis5. 1. Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. 2. Division of Internal Medicine, Emory University School of Medicine, Atlanta, Georgia. 3. Department of Bioinformatics, Emory University, Atlanta, Georgia. 4. Division of Cardiothoracic Surgery, Emory University School of Medicine, Atlanta, Georgia. 5. Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia. Electronic address: stam_lerakis@emoryhealthcare.org.
Abstract
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is increasingly being performed in cardiac catheterization laboratories using transthoracic echocardiography (TTE) to guide valve deployment. The risk of paravalvular regurgitation (PVR) remains a concern. METHODS: We retrospectively reviewed 454 consecutive patients (mean age, 82 ± 8; 58% male) who underwent transfemoral TAVR at Emory Healthcare from 2007 to 2014. Two hundred thirty-four patients underwent TAVR in the cardiac catheterization laboratory with TTE guidance (TTE-TAVR; mean Society of Thoracic Surgeons score, 10%), while 220 patients underwent the procedure in the hybrid operating room with transesophageal echocardiography (TEE) guidance (TEE-TAVR; mean Society of Thoracic Surgeons score, 11%). All patients received an Edwards valve (SAPIEN 55%, SAPIEN-XT 45%). Clinical and procedural characteristics, echocardiographic parameters, and incidence of PVR were compared. RESULTS: The incidence of at least mild PVR at discharge was comparable between TTE-TAVR and TEE-TAVR (33% vs 38%, respectively; P = .326) and did not differ when stratified by valve type. However, in the TTE-TAVR group, there was a higher incidence of second valve implantation (7% vs 2%; P = .026) and postdilation (38% vs 17%; P < .001) during the procedure. Although not independently associated with PVR at discharge (odds ratio = 1.12; 95% CI, 0.69-1.79), TTE-TAVR was associated with PVR-related events: the combined outcome of mild PVR at discharge, intraprocedural postdilation, and second valve insertion (odds ratio = 1.58; 95% CI, 1.01-2.46). There were no significant differences in PVR at 30 days, 6 months, and 1 year between the two groups. CONCLUSIONS: TTE-TAVR in a high-risk group of patients was associated with increased incidence of intraprocedure PVR-related events, although it was not associated with higher rates of PVR at follow-up. Multicenter randomized trials are required to confirm the cost-effectiveness and safety of TTE-TAVR.
BACKGROUND: Transcatheter aortic valve replacement (TAVR) is increasingly being performed in cardiac catheterization laboratories using transthoracic echocardiography (TTE) to guide valve deployment. The risk of paravalvular regurgitation (PVR) remains a concern. METHODS: We retrospectively reviewed 454 consecutive patients (mean age, 82 ± 8; 58% male) who underwent transfemoral TAVR at Emory Healthcare from 2007 to 2014. Two hundred thirty-four patients underwent TAVR in the cardiac catheterization laboratory with TTE guidance (TTE-TAVR; mean Society of Thoracic Surgeons score, 10%), while 220 patients underwent the procedure in the hybrid operating room with transesophageal echocardiography (TEE) guidance (TEE-TAVR; mean Society of Thoracic Surgeons score, 11%). All patients received an Edwards valve (SAPIEN 55%, SAPIEN-XT 45%). Clinical and procedural characteristics, echocardiographic parameters, and incidence of PVR were compared. RESULTS: The incidence of at least mild PVR at discharge was comparable between TTE-TAVR and TEE-TAVR (33% vs 38%, respectively; P = .326) and did not differ when stratified by valve type. However, in the TTE-TAVR group, there was a higher incidence of second valve implantation (7% vs 2%; P = .026) and postdilation (38% vs 17%; P < .001) during the procedure. Although not independently associated with PVR at discharge (odds ratio = 1.12; 95% CI, 0.69-1.79), TTE-TAVR was associated with PVR-related events: the combined outcome of mild PVR at discharge, intraprocedural postdilation, and second valve insertion (odds ratio = 1.58; 95% CI, 1.01-2.46). There were no significant differences in PVR at 30 days, 6 months, and 1 year between the two groups. CONCLUSIONS: TTE-TAVR in a high-risk group of patients was associated with increased incidence of intraprocedure PVR-related events, although it was not associated with higher rates of PVR at follow-up. Multicenter randomized trials are required to confirm the cost-effectiveness and safety of TTE-TAVR.
Authors: David A McNamara; Rajus Chopra; Jeffrey M Decker; Michael W McNamara; Stacie M VanOosterhout; Duane C Berkompas; Musa I Dahu; Mohamad A Kenaan; Wassim I Jawad; William M Merhi; Jessica L Parker; Ryan D Madder Journal: JAMA Netw Open Date: 2022-07-01
Authors: Lindsay E Bodart; Benjamin R Ciske; Jonathan Le; Nicole M Reilly; Roderick C Deaño; Steven M Ewer; Parag Tipnis; Peter S Rahko; Martin G Wagner; Amish N Raval; Michael A Speidel Journal: Med Phys Date: 2021-03-25 Impact factor: 4.071
Authors: Renuka Jain; Daniel P O'Hair; Tanvir K Bajwa; Denise Ignatowski; Daniel Harland; Amanda M Kirby; Tracy Hammonds; Suhail Q Allaqaband; Jonathan Kay; Bijoy K Khandheria Journal: Echo Res Pract Date: 2017-11-03