Abstract 8743: Assessment of Aortic Annulus Diameter with Three-dimensional Transesophageal Echocardiography: Implications for Transcatheter Aortic Valve Implantation
Background: Transcatheter aortic valve implantation (TAVI) relies on imaging of the aortic annulus for device sizing. 3D transesophageal echocardiography (TEE) may provide more accurate dimensions than 2DTEE because the annulus shape is oblong rather than circular. We compared 2DTEE and 3DTEE annular measurements and hypothesized that 3DTEE could impact strategy in TAVI by influencing the decision to implant a device and prosthesis size.
Methods: Annular diameter was measured with 2DTEE and 3DTEE in 41 consecutive patients with severe aortic stenosis who underwent TAVI. 2DTEE measurements were taken at the leaflet insertion points in the long axis view. 3DTEE diameter was calculated as the mean of minor and major axes measurements of the annulus, which was located at the base of all 3 leaflets from reconstructed orthogonal long and short axis views. Device implantation and prosthesis size were chosen based on manufacturer guidelines (Edwards Lifesciences, Irvine, CA) using perioperative 3DTEE measurements. Agreements between 2DTEE and 3DTEE measurements were assessed. Impact on TAVI strategy was determined if the 2DTEE measurement would Results in exclusion or selection of a different prosthesis size than what was chosen during the actual procedure.
Results: 3DTEE measurements of the annulus correlated well with 2DTEE (r = 0.77, p < 0.001). The difference (mean ± SEM) between 2DTEE and 3DTEE was 1.95 ± 1.43 mm. Agreement between prosthesis size chosen by 3DTEE (23 mm, n = 22; 26 mm, n = 19) and size predicted by 2TEE (23 mm, n = 8; 26 mm, n = 31) was modest (kappa = 0.37). Overall, 2DTEE would have changed TAVI strategy in 12 patients (33%), and specifically excluded device implantation in 2 patients. Post-TAVI, only 2 patients had clinically significant (> 2+) paravalvular or central aortic regurgitation.
Conclusions: Use of 3DTEE during TAVI improves visualization of annulus shape and may have important clinical implications for device sizing. The low incidence of clinically significant postoperative valve regurgitation in our study suggests appropriate sizing was obtained using 3DTEE. 2DTEE led to larger measurements than 3DTEE and would have changed strategy in 1/3 of patients, including the exclusion of patients who successfully underwent device implantation.
- Transesophageal echocardiography
- Aortic valve stenosis
- Valvular disease
- Aortic valve
- Interventional cardiology
- © 2010 by American Heart Association, Inc.