Abstract 11658: Three Dimensional Transesophageal Echocardiography in Transcatheter Aortic Valve Implantation - Comparison with 2D Data and Impact on Prosthesis Size Selection
Objectives: To compare aortic annulus diameters obtained by 3D transesophageal echocardiography (TEE) with 2D-TEE and the impact on prosthesis size selection in transcatheter aortic valve implantation (TAVI)
Background: In TAVI the aortic annulus diameter determines prosthesis size. The ideal modality for annulus assessment has not been defined yet.
Methods: Annulus diameters in 2D-TEE (long-axis view) and in 3D-TEE (long-axis view in multiple-plane-reconstruction) were compared in consecutive patients with aortic stenosis screened for TAVI. Prosthesis size was selected according to industry guidelines, integrating data from 3D-TEE, angiography and computed tomography. The percentage of cases in which 2D-TEE and 3D-TEE correctly predicted final prosthesis size was calculated.
Results: 49 patients were studied (Age 80±5, 39% male, logistic EuroScore 17±11%). Annulus diameters from 2D- and 3D-TEE correlated (r= .808, p<.0001). Mean diameters were significantly larger on 3D- vs. 2D-TEE (23.4±2.2 vs. 22.1±2.6mm, p<.001) with a mean difference of 1.2mm (limits of agreement: -1.8 to 4.3). The interobserver variability of 2D- and 3D-TEE was 3.5±5.6% and 0.9.±5.1%, respectively. 39 patients underwent TAVI (27 CoreValveTM, 12 Edwards SapienTM). The procedure was successful in 37 (93%) patients. Post-procedural regurgitation was none or mild in 89% of the cases with no severe insufficiency. Final prosthesis size was correctly predicted by 2D-TEE in 70% while in 92% by 3D-TEE. Overall, 3D-TEE suggested a different prosthesis size in 24% of all cases compared to 2D-TEE.
Conclusions: Aortic annulus measurement by 3D-TEE yields significantly larger diameters than 2D-TEE. This impacts prosthesis size selection in a considerable percentage of cases.
- © 2011 by American Heart Association, Inc.