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Transthoracic echocardiography is adequate for intraprocedural guidance of transcatheter aortic valve implantation
Echo research and practice
  • Renuka Jain, Aurora Health Care
  • Daniel O'Hair, Aurora Health Care
  • Tanvir K Bajwa, Aurora Health Care
  • Denise Ignatowski, Aurora Health Care
  • Daniel R Harland, Aurora Health Care
  • Amanda M Kirby, Aurora Health Care
  • Tracy Hammonds, Aurora Health Care
  • Suhail Q Allaqaband, Aurora Health Care
  • Jonathan Kay, Aurora Health Care
  • Bijoy K Khandheria, Aurora Health Care
Aurora Affiliations

Aurora Cardiovascular Services, Aurora Sinai/Aurora St. Luke's Medical Centers, Aurora Research Institute

Publication Date
12-1-2017
Abstract

BACKGROUND: While transcatheter aortic valve implantation (TAVI) has traditionally been supported intraprocedurally by transoesophageal echocardiography (TOE), transthoracic echocardiography (TTE) is increasingly being used. We evaluated echocardiographic imaging characteristics and clinical outcomes in patients who underwent TTE during TAVI (TTE-TAVI).

METHODS AND RESULTS: A select team of dedicated sonographers and interventional echocardiographers performed TTE-TAVI in 278 patients, all of whom underwent TAVI through transfemoral access. We implanted the Medtronic EVOLUT R valve in 258 patients (92.8%). TTE images were acquired immediately pre-procedure by a dedicated sonographer in the cardiac catheterization laboratory with the patient in the supine position. TTE was then performed post deployment of TAVI. In the procedure, TTE image quality was fair or better in 249 (89.6%) cases. Color-flow Doppler was adequate or better in 275 (98.9%) cases. In 2 cases, paravalvular regurgitation (PVL) could not be assessed confidently by echocardiography due to poor image quality; in those cases, PVL was assessed by fluoroscopy, aortic root injection and invasive hemodynamics. Both TTE and invasive hemodynamics were used in the assessment of need for post-deployment stent ballooning (

CONCLUSIONS: With the current generation of TAVI, TTE-TAVI is adequate intraprocedurally when performed by specialized sonographers and dedicated cardiologists in a highly experienced TAVI center.

Document Type
Article
PubMed ID
29101108
DOI
10.1530/ERP-17-0050
Citation Information

Jain R, O'hair DP, Bajwa TK, et al. Transthoracic echocardiography is adequate for intraprocedural guidance of transcatheter aortic valve implantation. Echo Res Pract. 2017;4(4):63-72. doi: 10.1530/ERP-17-0050.