Official journal of the Slovak Society of Cardiology,
Slovak Society of Hypertension and Slovak Association for Cardiac Arrhythmias

Cardiology Letters 2022, 31(3):184-195

Three-dimensional transesophageal echocardiography in transcatheter aortic valve implantation

Kurečko M1, Valočik G1, Kollárová A2
1 I. kardiologická klinika LF UPJŠ a VÚSCH, a. s., Košice
2 Klinika srdcovej chirurgie LF UPJŠ a VÚSCH, a. s., Košice, Slovenská republika

Background: Transcatheter aortic valve implantation (TAVI) is a minimally invasive and alternative treatment of severe symptomatic aortic stenosis (AoS) indicated in patients with high or intermediate surgical risk. Implantation of incorrect prosthesis size has direct impact on patient´s outcome after TAVI. Annular area, perimeter, area derived diameter, perimeter derived diameter (DP) and mean diameter are recommended in order to select the prosthesis size, based on the industry´s recommendations for TAVI valves.

Aim: The aim of this study was to demonstrate the influence of three dimenisonal (3D) transesophageal (TEE) aortic annulus parameters on the selection of the Edwards Sapien 3, balloon-expandable, prothesis size.

Methods: Forty four consecutive patients with severe symptomatic AoS, who underwent pre-TAVI 3D TEE assessment of the aortic root, were prospectively included in this study. We assigned the appropriate prosthesis size to each parameter of the aortic annulus. Postprocedurally, we compared the agreement between implanted prosthesis size and the prosthesis sizes recommended by the individual parameters.

Results: According to the results of our study, DP appears to be the most robust parameter in TAVI prosthesis size selection. The best agreement with implanted size of TAVI valve was shown for DP (in 68.2% of cases). In addition, the use of DP in prosthesis size selection was not associated with a higher incidence of paravalvular regurgitation (p = 0.7 - 0.9) or postprocedural pacemaker implantations (p = 0.1).

Conclusion: The study demonstrates that the use of different annular dimensions obtained in the same patient during the same phase of a cardiac cycle can lead to the selection of a different prosthesis size.

Keywords: transcatheter aortic valve implantation; aortic annulus; three-dimensional transesophageal echocardiography; area derived diameter; perimeter derived diameter; aortic stenosis

Published: March 1, 2022  Show citation

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Kurečko M, Valočik G, Kollárová A. Three-dimensional transesophageal echocardiography in transcatheter aortic valve implantation. Cardiology Letters. 2022;31(3):184-195.
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