Large-field intravascular ultrasound for annular sizing and predicting paravalvular regurgitation during TAVR: comparisons with multidetector computed tomography and transoesophageal echocardiography

Hakim, Diaa; Ghimire, Gopal; Alli, Oluseun; Singh, Satinder P.; Sasse, Mark; Booker, Oscar Julian; Arora, Garima; Leesar, Tara; Jernigan, Lindsey; Melby, Spencer J.; Davies, James E.; Leesar, Massoud A.

doi:10.1093/ehjci/jew322

Cited by 7 publications

(13 citation statements)

References 16 publications

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“…38 These studies accentuate the potential of IVUS as an adjunct in TAVI to reduce contrast volume and risk for AKI. [33][34][35]37,38 However, they are mainly limited to preimplantation evaluation, with the exclusion of Roy et al who also assessed postimplantation valve leaflet function and frame expansion. 31,32 Our findings agree with the above studies regarding the potential of IVUS for preimplantation evaluation.…”

Section: Discussionmentioning

confidence: 99%

“…While it was possible to evaluate the circular valve expansion, a functional post-deployment assessment of the prosthesis was not possible. With respect to possible differences of IVUS measurements in pigs as compared to humans, relevant deviations seem unlikely given the similar anatomy of the aortic root in humans and pigs and the existing experience of large-field IVUS measurements of the aortic annulus dimensions by Hakim et al 35 To investigate reproducibility and safety as well as further limitations and advantages, including a possible reduction of fluoroscopy time, further study with a bigger population is necessary.…”

Section: Study Limitationsmentioning

confidence: 99%

“…[24][25][26][27][28][29][30] Roy et al first reported IVUS for the assessment of aortic valve anatomy pre-TAVI, and the accuracy of IVUS compared to computed tomography for annulus-sizing prior to TAVI has already been investigated with promising results. [31][32][33][34][35] However, research on IVUS-guided valve deployment is lacking. The present study, therefore, investigates the feasibility of a novel contrast-free approach that broadens IVUS guidance to all steps of the procedure.…”

Section: Introductionmentioning

confidence: 99%

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Intravascular Ultrasound-Guided Contrast-Free Transcatheter Aortic Valve Implantation: A Porcine Feasibility Study

Krapf

Altaner

Martini

et al. 2021

Innovations�(Phila)

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Objective Patients undergoing transcatheter aortic valve implantation (TAVI) frequently present with chronic kidney disease and are therefore particularly susceptible to nephrotoxic influences like iodinated contrast media. Acute kidney injury after TAVI is a severe complication that independently predicts short- and long-term mortality. The present study investigates the feasibility of a contrast-free approach by using intravascular ultrasound (IVUS) in conjunction with fluoroscopy. Methods Six domestic pigs (60 ± 5 kg) were anesthetized and underwent transapical implantation of a balloon-expandable transcatheter heart valve. In the control group ( n = 3), the procedures were guided by fluoroscopy/angiography. In the study group ( n = 3), the procedures were guided by IVUS for preimplantation evaluation, intra-procedural guidance, and post-implantation evaluation, in conjunction with fluoroscopy without contrast. The procedures were evaluated by IVUS, fluoroscopy, aortic root angiography, and explantation and dissection of the hearts. Results Relevant anatomical landmarks for correct implantation were assessed by IVUS. The following annulus measurements were obtained: area (359.67 ± 29.58 mm2), perimeter (68.28 ± 2.63 mm), maximum diameter (22.20 ± 1.22 mm), minimum diameter (20.43 ± 1.12 mm), mean diameter (21.32 ± 0.70 mm), ellipticity index (1.09 ± 0.10), and area-derived diameter (21.39 ± 0.87 mm). IVUS-guided valve deployment resulted in correct expansion within the aortic annulus without signs of paravalvular leak, compromised mitral valve, or coronary obstruction. IVUS-guided post-implantation assessment confirmed circular expansion (25.88 ± 0.30 mm) of the valves. Conclusions IVUS-guided, contrast-free transapical TAVI is feasible in a porcine model.

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Section: Discussionmentioning

confidence: 99%

Section: Study Limitationsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Intravascular Ultrasound-Guided Contrast-Free Transcatheter Aortic Valve Implantation: A Porcine Feasibility Study

Krapf

Altaner

Martini

et al. 2021

Innovations�(Phila)

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“…Computed tomography (CT) is currently the standard of care for preoperative evaluation because it offers more obvious contrast between the vascular and nonvascular structures and facilitates accurate measurements [ 5 ] (Fig. 1 ).…”

Section: Introductionmentioning

confidence: 99%

Application of three-dimensional transesophageal echocardiography in preoperative evaluation of transcatheter aortic valve replacement

Ding

Liu

et al. 2021

BMC Cardiovasc Disord

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Background Our goal was to determine the accuracy of 3-dimensional transesophageal echocardiography (3D-TEE) compared with that of computed tomography (CT) in the preoperative evaluation for transcatheter aortic valve replacement (TAVR) when the errors caused by inconsistent software and method have been eliminated and the representativeness of the sample has been improved. We also investigated the influence of aortic root calcification on the accuracy of 3D-TEE in aortic annulus evaluations. Methods Part I: 45 of 233 patients who underwent TAVR in the department of cardiovascular surgery at the Xijing hospital from January 2016 to August 2019 were studied retrospectively. Materialise Mimics software and the multiplanar reconstruction method were used for evaluation, based on 3D-TEE and CT. The annulus area-derived diameter, the annulus perimeter-derived diameter (Dp), the annulus mean diameter, the left ventricular outflow tract Dp diameter, the sinotubular junction (STJ) diameter-Dp, and the aortic sinus diameter were compared and analyzed. Part II: 31 of 233 patients whose 3D-TEE and CT data were well preserved and in the required format were included. HU450 and HU850 were used as indicators to measure the severity of calcification. The Spearman rank correlation and Linear regression were used to analyze the correlation between aortic root calcification and the accuracy of 3D-TEE in aortic annulus measurement. Results The measurement results based on 3D-TEE were significantly lower than those obtained using CT (P < 0.05), except for the STJ diameter-Dp in diastole (P = 0.11). The correlation coefficient of the two groups was 0.699–0.954 (P < 0.01), which also indicated a significant correlation between the two groups. A Bland–Altman plot showed that the ordinate values were mostly within the 95% consistency limit; the consistency of the two groups was good. By establishing the linear regression equation, the two groups can be inferred from each other. The Spearman rank correlation analysis and the Linear regression analysis showed that the influence of aortic calcification on the accuracy of the 3D-TEE annulus evaluation was limited. Conclusions Although an evaluation based on 3D-TEE underestimated the results, we can deduce CT results from 3D-TEE because the two methods exhibit considerable correlation and consistency. Trial registration Name: Surgery and Transcatheter Intervention for Structural Heart Diseases. Number: NCT02917980. URL: https://clinicaltrials.gov/ct2/results?term=NCT02917980.

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“…Computed tomography (CT) is currently the standard of care for preoperative evaluation as it offers more obvious contrast between the vascular and non-vascular structures and facilitate accurate measurement (5) (Fig. 1).…”

Section: Introductionmentioning

confidence: 99%

Application of Three-Dimensional Transesophageal Echocardiography in Preoperative Evaluation of Transcatheter Aortic Valve Replacement

Ding

Liu

et al. 2020

Preprint

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BackgroundAnalysing the accuracy of 3D-TEE in preoperative evaluation of TAVR compared with CT when the error led by inconsistent software and method has been eliminated and the representativeness of sample has been improved, and exploring the influence of aortic root calcification on the accuracy of 3D-TEE in aortic annulus evaluations.MethodsPart I: 45 of 233 patients who underwent TAVR in the department of cardiovascular surgery in Xijing hospital from January 2016 to August 2019 were retrospectively studied. Mimics and multiplanar reconstruction method were used for evaluation based on 3D-TEE and CT. Annulus diameter - area derived (Da), annulus diameter - perimeter derived (Dp), annulus mean diameter, the left ventricular outflow tract (LVOT) diameter-Dp, the sinus tube junction (STJ) diameter-Dp and aortic sinus diameter were compared and analyzed. Part ii: 31 of 233 patients whose 3D-TEE and CT data were well preserved and in the required format were included. HU450 and HU850 were used as indicators to measure the severity of calcification, and spearman rank correlation and ROC curve was used to analyze the correlation between aortic root calcification and accuracy of 3D-TEE in aortic annulus measurement.ResultsThe measurement results based on 3D-TEE were significantly lower than those of CT (p<0.05), except for the STJ diameter-Dp in diastole (p=0.11). The correlation coefficient of the two groups was 0.699 ~ 0.954 (p < 0.01), which also indicated a significant correlation between the two groups.Bland-Altman plot showed that the ordinate values were mostly within the 95% consistency limit, the consistency of the two groups was good. By establishing the linear regression equation, the two groups can be inferred from each other. Spearman rank correlation analysis and ROC curve analysis showing that the influence of aortic calcification on the accuracy of 3D-TEE annulus evaluation was limited.ConclusionsWhlie evaluation based on 3D-TEE underestimated the results, we can deduce CT results from 3D-TEE as they obtain considerable correlation and consistency. Calcification in the aortic sinus did not affect the accuracy of 3D-TEE annulus evaluation.Trial registrationName: Surgery and Transcatheter Intervention for Structural Heart DiseasesNumber: NCT02917980URL : https://clinicaltrials.gov/ct2/results?term=NCT02917980

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Large-field intravascular ultrasound for annular sizing and predicting paravalvular regurgitation during TAVR: comparisons with multidetector computed tomography and transoesophageal echocardiography

Cited by 7 publications

References 16 publications

Intravascular Ultrasound-Guided Contrast-Free Transcatheter Aortic Valve Implantation: A Porcine Feasibility Study

Intravascular Ultrasound-Guided Contrast-Free Transcatheter Aortic Valve Implantation: A Porcine Feasibility Study

Application of three-dimensional transesophageal echocardiography in preoperative evaluation of transcatheter aortic valve replacement

Application of Three-Dimensional Transesophageal Echocardiography in Preoperative Evaluation of Transcatheter Aortic Valve Replacement

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