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Singh S, Rutkowski PS, Dyachkov A, Iyer VS, Pourafkari L, Nader ND. A discrepancy between CT angiography and transesophageal echocardiographic measurements of the annular size affect long-term survival following trans-catheter aortic valve replacement. J Cardiovasc Thorac Res 2021; 13:208-215. [PMID: 34630968 PMCID: PMC8493236 DOI: 10.34172/jcvtr.2021.39] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2020] [Accepted: 07/18/2021] [Indexed: 02/06/2023] Open
Abstract
Introduction: Accurate measurement of the aortic valve annulus is critical for proper valve sizing for the transcatheter aortic valve replacement (TAVR) procedure. While computed tomography angiography (CTA) is the widely-accepted standard, two-dimensional (2D) and three-dimensional(3D) transesophageal echocardiography (TEE) is commonly performed to measure the size of the aortic valve and to verify appropriate seating of prostheses. Methods: Patients undergoing TAVR between 2013-2015 were examined. 2D- and 3D-TEEmeasurements were compared to CTA taken as standard. Patients were followed for at least one year. The presence and effect of discrepancy (defined as a difference of more than 10%) between CTA and TEE measurements on survival were examined. Results: One hundred eighty-five patients (70 men) were included. 2D- and 3D-TEE measurements underestimated the annulus size by -1.49 and -1.32 mm, respectively. Discrepancies > 10% between TEE and CTA methods in estimating the aortic annulus size were associated with a decrease in post implant survival. The peak pressure gradient across the aortic prosthesis measured one year after the implant was higher in patients with an initial discrepancy between 3D-TEE and CTA measurements. In a multivariate cox-regression model, the discrepancy between CTA and 2D-TEE readings and the smaller size of the aortic annular area were the predictors of long-term survival. Conclusion: Both 2D and 3D-TEE underestimate the aortic annulus measurements compared to CTA, with 2D-TEE being relatively more precise than 3D-TEE technology. The presence of a discrepancy between echocardiographic and CTA measurements of the aortic annulus is associated with a lower survival rate.
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Affiliation(s)
- Siddarth Singh
- Department of Anesthesiology, University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
| | - Piotr S Rutkowski
- Department of Anesthesiology, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Alexey Dyachkov
- Department of Anesthesiology, Geisinger Medical Center, Danville, PA, USA
| | - Vijay S Iyer
- Gates Vascular Institute, Interventional Cardiology, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Leili Pourafkari
- Catholic Health System, University at Buffalo Jacob's School of Medicine and Biomedical Sciences, Buffalo, NY, USA
| | - Nader D Nader
- Department of Anesthesiology, University at Buffalo, School of Medicine and Biomedical Sciences, Buffalo, NY, USA
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Aalaei-Andabili SH, Lee TC, Waheed N, Bavry AA, Petersen JW, Wayangankar S, Arnaoutakis GJ, David Anderson R, Beaver TM. Impact of Valve Size on Prosthesis-Patient Mismatch and Aortic Valve Gradient After Transcatheter versus Surgical Aortic Valve Replacement. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2019; 14:243-250. [PMID: 31074313 DOI: 10.1177/1556984519838706] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE Limited data is available about the effect of implanted valve size on prosthesis-patient mismatch (PPM) incidence and aortic gradient (AG) after transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR). We compared PPM incidence and postprocedural AG between TAVR and SAVR patients considering the impact of implanted valve size. METHODS From March 20, 2012, to September 30, 2015, 563 consecutive patients underwent TAVR (n = 419) or isolated SAVR (n = 144). Postprocedural transthoracic echocardiography was obtained within 30 days; AG, effective orifice area (EOA), and EOA index were calculated. RESULTS A total of 381 patients in TAVR group and 82 patients in SAVR group were included. Mean preoperative AG and mean aortic valve area were not significantly different between the 2 groups. Postprocedural AG was significantly lower in TAVR than SAVR group, 7.74 ± 5.39 versus 14.27 ± 8.16 (P < 0.001). Between patients who had TAVR and SAVR with a valve size ≤23 mm, SAVR patients were 3 times more likely to have greater than mild AG after the procedure, OR: 3.1 (95% CI, 1.1 to 8.9) (P < 0.001). PPM incidence was significantly higher in SAVR group than TAVR group, 44 (53.7%) versus 112 (29.4%), OR = 2.8 (95% CI, 1.7 to 4.5) (P < 0.001). The PPM incidence was also higher in SAVR group than TAVR group among those who had the procedures with a valve size ≤23 mm, 35 (64.8%) versus 56 (47.9%), OR = 2 (95% CI, 1.1 to 3.9) (P = 0.048). Postprocedural outcomes were comparable between the 2 groups. CONCLUSIONS In comparison to SAVR, TAVR is associated with less PPM and lower AG, especially in patients receiving a valve size ≤23 mm.
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Affiliation(s)
- Seyed Hossein Aalaei-Andabili
- 1 Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA.,2 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
| | - Teng C Lee
- 2 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA.,3 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of California, San Francisco, CA, USA
| | - Nida Waheed
- 1 Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Anthony A Bavry
- 1 Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - John W Petersen
- 1 Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Siddharth Wayangankar
- 1 Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - George J Arnaoutakis
- 1 Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - R David Anderson
- 1 Division of Cardiology, Department of Medicine, University of Florida, Gainesville, FL, USA
| | - Thomas M Beaver
- 2 Division of Thoracic and Cardiovascular Surgery, Department of Surgery, University of Florida, Gainesville, FL, USA
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León del Pino MDC, Ruíz Ortiz M, Delgado Ortega M, Sánchez Fernández J, Ferreiro Quero C, Durán Jiménez E, Romero Moreno M, Segura Saint-Gerons J, Ojeda Pineda S, Pan Álvarez-Ossorio M, Mesa Rubio D. Prosthesis-patient mismatch after transcatheter aortic valve replacement: prevalence and medium term prognostic impact. Int J Cardiovasc Imaging 2019; 35:827-836. [DOI: 10.1007/s10554-018-01519-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 12/24/2018] [Indexed: 01/01/2023]
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Nakashima M, Watanabe Y, Hioki H, Nara Y, Nagura F, Hosogoe N, Kawashima H, Kataoka A, Otsuki S, Konno K, Kyono H, Yokoyama N, Kozuma K. Efficacy and safety of transcatheter aortic valve implantation with Edwards SAPIEN 3 and XT in smaller Asian anatomy. Cardiovasc Interv Ther 2017; 33:384-390. [PMID: 29185181 DOI: 10.1007/s12928-017-0502-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2017] [Accepted: 11/20/2017] [Indexed: 12/19/2022]
Abstract
We aimed to compare the efficacy and safety of transcatheter aortic valve implantation (TAVI) using Edwards SAPIEN 3 (S3) valve and SAPIEN XT) in smaller anatomy. The new generation S3 TAVI device has been used worldwide; however, its efficacy and safety in smaller Asian anatomy remain unknown. Between February 2014 and March 2017, 166 consecutive patients (S3, 54; XT, 112) were treated with balloon-expandable TAVI in a single center and their outcomes were analyzed. Median patient age was 85 (range: 81-88) years and mean body surface area was 1.41 ± 0.15 m2. A 23-mm size valve was used in S3 and XT groups (70 vs. 62%, p = 0.224). The transfemoral approach was more frequently used in the S3 than in the XT group (96 vs. 72%, p < 0.001). Although, the minimal luminal diameter of the femoral artery was smaller in the S3 group (5.9 vs. 6.4 mm, p = 0.001), the rates of major (2 vs. 11%, p = 0.226) and minor (11 vs. 5%, p = 0.107) vascular complications did not increase. The frequency of paravalvular leaks (PVL) ≥ 2 was significantly reduced in the S3 group (11 vs. 61%, p < 0.001); however, pre- (24 vs. 91%, p < 0.001) and post- (4 vs. 19%, p < 0.001) dilatations were less frequently performed. Pacemaker implantation incidence did not increase (4 vs. 5%, p = 1.0) and peak velocity of the transcatheter heart valve was significantly higher in the S3 group (2.3 vs. 2.2 m/s, p = 0.046). Device success was high (89 vs. 93%, p = 0.387) while the 30-day all-cause mortality was low (2 vs. 1%, p = 0.583) in both groups. TAVI with the S3 device was safe and effective, with low incidence of vascular complications and reduced PVL, in smaller body-sized Asians.
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Affiliation(s)
- Makoto Nakashima
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan.
| | - Yusuke Watanabe
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Hirofumi Hioki
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Yugo Nara
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Fukuko Nagura
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Naoyoshi Hosogoe
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Hideyuki Kawashima
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Akihisa Kataoka
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Shuji Otsuki
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Kumiko Konno
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Hiroyuki Kyono
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Naoyuki Yokoyama
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
| | - Ken Kozuma
- Department of Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo, 173-0003, Japan
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Liao YB, Li YJ, Jun-Li L, Zhao ZG, Wei X, Tsauo JY, Xiong TY, Xu YN, Feng Y, Chen M. Incidence, Predictors and Outcome of Prosthesis-Patient Mismatch after Transcatheter Aortic Valve Replacement: a Systematic Review and Meta-analysis. Sci Rep 2017; 7:15014. [PMID: 29118326 PMCID: PMC5678180 DOI: 10.1038/s41598-017-15396-4] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/26/2017] [Indexed: 02/05/2023] Open
Abstract
The aim of this study was to investigate the incidence, predictors and outcome of prosthesis-patient mismatch (PPM) following transcatheter aortic valve replacement (TAVR). A total of 30 articles incorporating 4,691 patients were identified. The pooled incidences of overall, moderate and severe PPM following TAVR were 33.0%, 25.0% and 11.0% respectively. Medtronic CoreValve (MCV) had lower incidence of overall (32% vs: 40%, P < 0.0001) and moderate (23% vs 32%, P < 0.0001) than Edwards Sapien (ESV). PPM was associated with a younger age, smaller annulus diameter and lower left ventricular ejection fraction in comparison with those patients without PPM. Post-dilation (OR, 0.51, 95% CI, 0.38 to 0.68, p < 0.001) during TAVR would decrease the incidence of PPM. Although PPM was common after TAVR, no significant differences were observed both in short- and mid-term all-cause mortality (30 day: OR: 1.1, 95% CI, 0.70 to 1.73 and 2 year: OR: 1.01, 95% CI, 0.74 to 1.38) between patients with PPM and those without PPM. In conclusion, despite being common after TAVR, the incidence of PPM was lower than that of surgical aortic valve replacement (SAVR) and decreased with the experience accumulating, and PPM was not seen to impact on short- and mid-term survival, regardless of its magnitude.
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Affiliation(s)
- Yan-Biao Liao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yi-Jian Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Li Jun-Li
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Zhen-Gang Zhao
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Xin Wei
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Jiay-Yu Tsauo
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Tian-Yuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yuan-Ning Xu
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China
| | - Yuan Feng
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China.
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, 37 Guoxue Street, Chengdu, 610041, P. R. China.
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Subramaniam K, Nazarnia S. Prosthesis-patient mismatch - what cardiac anesthesiologists need to know? Ann Card Anaesth 2017; 20:234-242. [PMID: 28393786 PMCID: PMC5408531 DOI: 10.4103/aca.aca_9_17] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Prosthesis-patient Mismatch (PPM) is not uncommon with an incidence reported up to 70% after aortic valve (AV) replacement. Severe forms of PPM are less common (up to 20%); PPM can lead to increased short- and long-term morbidity and mortality. It is important to discriminate PPM from other forms of prosthetic valve dysfunction. Sometimes, prosthetic valve degenerative disease may coexist with PPM. Echocardiography plays an important role in the prevention and diagnosis of PPM. Preemptive strategies to prevent PPM include insertion of newer generation prosthetic valves with better hemodynamic characteristics, stentless prosthesis, aortic root enlargement to insert a larger prosthesis, aortic homograft, and transcutaneous AV implantation. We present an illustrative case and review the literature on PPM pertinent to anesthesiologists.
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Poulin F, Yingchoncharoen T, Wilson WM, Horlick EM, Généreux P, Tuzcu EM, Stewart W, Osten MD, Woo A, Thavendiranathan P. Impact of Prosthesis-Patient Mismatch on Left Ventricular Myocardial Mechanics After Transcatheter Aortic Valve Replacement. J Am Heart Assoc 2016; 5:JAHA.115.002866. [PMID: 26857069 PMCID: PMC4802434 DOI: 10.1161/jaha.115.002866] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
Background The aim of this study was to compare left ventricular (LV) remodeling using myocardial strain between patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) with and without prosthesis‐patient mismatch (PPM). Methods and Results In a retrospective study, speckle‐tracking echocardiography was used to measure global longitudinal strain (GLS) and strain rate (GLSR), circumferential strain, and rotation before and at mid‐term follow‐up post‐TAVR. Moderate and severe PPM were defined as an effective orifice area ≤0.85 and <0.65 cm2/m2, respectively. A total of 102 patients (median age, 83 years [77–88]) with severe AS were included. At 6±3 months post‐TAVR, moderate and severe PPM were found in 32 (31%) and 9 (9%) patients. Patients without PPM had a significant regression in LV mass (from 134±41 to 119±38 g/m2; P=0.001) at follow‐up whereas those with PPM did not. There was a significant improvement in LV GLS (−12.8±4.0 to −14.3±4.3%; P=0.01), GLSR (−0.61±0.20 to −0.73±0.25 second−1; P<0.001), and early diastolic strain rate (0.52±0.20 to 0.64±0.20 second−1; P<0.001) in patients without PPM, but not in those with PPM. After adjustment for pre‐TAVR ejection fraction and post‐TAVR aortic regurgitation, patients without PPM had greater improvement in LV longitudinal strain parameters compared to those with PPM. After a median follow‐up of 46.1 months (interquartile range, 35.4–60.8), there was no difference in survival between patients with and without PPM. Conclusions TAVR was associated with an incidence of PPM of 40%. Greater reverse LV remodeling using myocardial strain was evident in patients without PPM compared to PPM. Presence of PPM was not associated with mortality.
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Affiliation(s)
- Frédéric Poulin
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada Research Center, Hôpital du Sacré-Coeur de Montréal, University of Montreal Montreal Quebec, Canada
| | | | - William M Wilson
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada
| | - Eric M Horlick
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada
| | - Philippe Généreux
- Research Center, Hôpital du Sacré-Coeur de Montréal, University of Montreal Montreal Quebec, Canada
| | | | | | - Mark D Osten
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada
| | - Anna Woo
- Peter Munk Cardiac Center, Toronto General Hospital, University of Toronto Toronto Ontario, Canada
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