Aortic Annular Sizing Using Novel Software in Three-Dimensional Transesophageal Echocardiography for Transcatheter Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Abstract

(1) Background: We performed this study to evaluate the agreement between novel automated software of three-dimensional transesophageal echocardiography (3D-TEE) and multidetector computed tomography (MDCT) for aortic annular measurements of preprocedural transcatheter aortic valve replacement (TAVR); (2) Methods: PubMed, EMBASE, Web of Science, and Cochrane Library (Wiley) databases were systematically searched for studies that compared 3D-TEE and MDCT as the reference standard for aortic annular measurement of the following parameters: annular area, annular perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter. Meta-analytic methods were utilized to determine the pooled correlations and mean differences between 3D-TEE and MDCT. Heterogeneity and publication bias were also assessed. Meta-regression analyses were performed based on the potential factors affecting the correlation of aortic annular area; (3) Results: A total of 889 patients from 10 studies were included in the meta-analysis. Pooled correlation coefficients between 3D-TEE and MDCT of annulus area, perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter measurements were strong 0.89 (95% CI: 0.84–0.92), 0.88 (95% CI: 0.83–0.92), 0.87 (95% CI: 0.77–0.93), 0.87 (95% CI: 0.77–0.93), 0.79 (95% CI: 0.64–0.87), and 0.75 (95% CI: 0.61–0.84) (Overall p < 0.0001), respectively. Pooled mean differences between 3D-TEE and MDCT of annulus area, perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter measurements were −20.01 mm2 ((95% CI: −35.37 to −0.64), p = 0.011), −2.31 mm ((95% CI: −3.31 to −1.31), p < 0.0001), −0.22 mm ((95% CI: −0.73 to 0.29), p = 0.40), −0.47 mm ((95% CI: −1.06 to 0.12), p = 0.12), −1.36 mm ((95% CI: −2.43 to −0.30), p = 0.012), and 0.31 mm ((95% CI: −0.15 to 0.77), p = 0.18), respectively. There were no statistically significant associations with the baseline patient characteristics of sex, age, left ventricular ejection fraction, mean transaortic gradient, and aortic valve area to the correlation between 3D-TEE and MDCT for aortic annular area sizing; (4) Conclusions: The present study implies that 3D-TEE using novel software tools, automatically analysis, is feasible to MDCT for annulus sizing in clinical practice.

Transcatheter aortic valve replacement: Past, present, and future

“…Yet, despite its clear advantages, MDCT requires administration of a contrast medium and therefore may not be suitable for patients with renal impairment or contrast allergies 13,14 . In such cases, 3‐dimensional TOE could be used as a viable alternative, with recent evidence showing that it correlates well with MDCT when assessing the aortic annulus parameters 64,65 …”

“… 13 , 14 In such cases, 3‐dimensional TOE could be used as a viable alternative, with recent evidence showing that it correlates well with MDCT when assessing the aortic annulus parameters. 64 , 65 …”

The perfect prosthesis/patient match: pursuit of the Holy Grail

“…Pooled correlation coefficients between 3D-TEE and MDCT annulus area, perimeter, area derived-diameter, perimeter derived-diameter, maximum and minimum diameter measurements were strong: 0.89 [95% confidence interval (CI): 0.84–0.92], 0.88 (95% CI: 0.83–0.92), 0.87 (95% CI: 0.77–0.93), 0.87 (95% CI: 0.77–0.93), 0.79 (95% CI: 0.64–0.87), and 0.75 (95% CI: 0.61–0.84) (overall P<0.0001). The study implied that 3D-TEE, using novel software tools, is feasible to MDCT for annulus sizing in clinical practice ( 15 ). Currently, CT scan-derived root and annular dimensions are the standard of care in the United States (US) of America.…”

The Chinese Experience of Imaging in Cardiac Intervention

“…73,74 Beyond that, transesophageal echocardiography (TEE) avoids thoracic and lung interference and the imaging is more precise, which improves the sensitivity and reliability of transthoracic ultrasound. By taking preoperative and intraoperative realtime measurements of cardiac structures, TEE may provide surgical guidance in congenital heart disease, 75 atrioventricular septal defects, 76,77 transcatheter aortic valve replacement (TAVR) 78 and left atrial appendage (LAA) closure, 79 and predict postoperative complications. 75,80 Further, real-time 3D-TEE optimizes the spatial and temporal resolution and enables an en face view, thereby significantly enhancing the visualization of a complex 3D structure.…”