Abstract 18567: Transcatheter Transapical Aortic Valve Implantation Primarily Guided by Transesophageal Echocardiography
Background: Transapical aortic valve implantation (TAVI) is usually performed using angiography for prosthesis positioning and deployment. The objectives were 1) to determine the usefulness of transesophageal echocardiography (TEE) as the primary technique guiding TAVI; and 2) to compare TEE vs. angiography as primary imaging techniques for TAVI guidance.
Methods and Results: Eighty-three consecutive high-risk patients (79±9 years, logistic EuroSCORE: 27.4±17.7%) who underwent TAVI with the Edwards-SAPIEN valve were included. All procedures were performed in an operating room with a standard C-arm for fluoroscopic guidance. TAVI was primarily guided by angiography in the first 25 patients (A-TAVI) and by TEE in the last 58 patients (TEE-TAVI). TEE-TAVI patients exhibited a greater (P=0.03) degree of renal dysfunction and a higher (P=0.007) rate of moderate/severe mitral regurgitation. The procedure was successful in 100% (A-TAVI) and 98% (TEE-TAVI) (P=1.0). TEE-TAVI was associated with lower contrast volume (13±16 mL vs. 40±24 mL, P<0.0001). There were no differences between groups on the occurrence of valve malposition requiring the implantation of a second valve and/or valve embolization (TEE-TAVI: 5% A-TAVI: 8%, P=0.63). Fifteen patients in the TEE-TAVI group underwent TAVI without contrast (full-TEE-guided), with no cases of valve malposition/ embolization. The 30-day mortality rate was 16% (TEE-TAVI) vs. 12% (A-TAVI) (P=1.0). There was a significant reduction in mean aortic gradient and increase in aortic valve area (P<0.0001, for both) following TAVI, with no differences between TEE-TAVI/A-TAVI groups (P=0.79, P=0.45, respectively). Most patients had trivial/mild aortic regurgitation post-TAVI, with no differences between TEE-TAVI/A-TAVI groups (P=0.32). Despite of a higher degree of baseline renal dysfunction in the TEE-TAVI group, the incidence of post-procedural acute kidney injury was similar in both groups, P=0.75.
Conclusions: TEE-TAVI was associated with similar clinical and hemodynamic results than A-TAVI, supporting the feasibility and safety of TAVI procedures performed in an operating room without hybrid facilities.
- © 2010 by American Heart Association, Inc.