Abstract 15197: Echocardiographic Evaluation of Paravalvular Regurgitation After Transarterial Valve Implantation Based on the Academic Valve Research Consortium 2 Recommendations
Introduction: Recently, a simple scheme of semiquantitative evaluation of paravalvular regurgitation (PVR) severity on TTE in parasternal short axis (SAX) after transarterial valve replacement (TAVR) was proposed by core labs.
Hypothesis: This method is accurate and feasible to be used in clinical echo labs.
Methods: Between 2014- 2015, 216 pts underwent commercially TAVR , 60 Edwards Sapiens (ES) and 156 Medtronic CoreValve systems (CVC). Mean (sd) age 84.5 (7) years, 52% males, EF 57(13)%, 90% had a transfemoral access, median f/u, 40 days. The immediately post TAVR echo (echo 1) was compared with the last f/u echo in the database (echo 2). PVR circumferential extent was graded in SAX as trace, pinpoint jet, and a jet arc length up to 9.9%, 10-30% and > 30% of the annulus circumference indicating mild, moderate and severe PVR, respectively. A paired-t-test, ANOVA adjusted for age, sex, BSA, EF and valve type, and Pearson correlation were used. For interobserver reliability, intra class correlation coefficient (ICC) was calculated in 20 pts.
Results: ICC was 0.92 and 0.93 for echo 1 and echo 2, respectively. Mean PVR (sd) at echo 1 was 6.06 (8.58)% for ES and 10.04 (9.62)% for CVC , with no differences at echo 2. At the end of f/u, PVR was 74% none/trace, 15% mild, 9% moderate and 2% severe for ES and 69% , 19%, 10% and 2% respectively for CVC (p=0.41). The correlation coefficients (p-values) of PVR by echo in SAX with reported echo diagnosis and with other echo methods was 0.59 (<0.0001) and 0.71 (<0.0001), respectively. At the end of f/u, there was an overall significant decline in PVR severity (table). Individually, for CVC, 6%, 95% CI: 4%, 8%; p<.0001, and for ES 2.7 % (p=0.14).
Conclusions: 1. In a TAVR Program using a “real world” clinical echo lab, the incidence of PVR and its natural history are comparable with those reported by core labs. 2. The proposed semiquantitative assessment of PVR severity by TTE in SAX is potentially a robust and quick method to be used for the evaluation of PVR after TAVR.
Author Disclosures: D. Alexandru: None. S. Pollack: None. F. Petillo: None. D. Mihalatos: None. E. Barasch: None.
- © 2016 by American Heart Association, Inc.