Normal values for Doppler echocardiographic assessment of prosthetic valve function after transcatheter aortic valve replacement: a systematic review and meta-analysis

Abstract

Transcatheter aortic valve replacement has emerged as valuable treatment modality for patients with severe aortic stenosis and an unacceptable risk/benefit ratio for open heart surgery, but particularities specific to TAVR and a rapidly growing number of available TAVR prosthesis make post-procedural assessment of valve function challenging. Aim of the present analysis was to collect and pool all available data currently in the literature regarding normal doppler values for transcatheter prosthetic heart valves and to provide a comprehensive overview. A PRISMA checklist-guided systematic review and meta-analysis of prospective observational studies or national and device specific registries or randomized clinical trials was conducted. Studies were identified by searching PUBMED, SCOPUS, Cochrane Central Register of Controlled Trials and LILACs from January 2000 to March 2017. Out of 240 abstracts, 155 studies reporting echocardiographic parameter for twelve different valves prosthesis in a total of 27,159 patients were in included in this meta-analysis. The means and standard deviations of peak velocity, peak gradient, mean gradient and effective orifice were extracted and pooled from the included studies. The pooled means and standard deviations for all available TAVR prosthesis were classified according to implanted valve size and time since implantation. The present study firstly describes a pooled analysis of normal values for all available TAVR prosthesis in order to empower treating physicians with a reliable tool to perform follow-up echocardiographic assessment in TAVR patients and to safely identify patients with prostheses dysfunction.

Evolution of outcome and complications in TAVR: a meta-analysis of observational and randomized studies

“…This may be attributed to various factors in the evolution of TAVR over the last decade. First, the technological advances leading to an improved hemodynamic performance and increased safety profile 12 . Secondly, a shift of risk starting with high risk patients in the advent of TAVR, now pushing the frontier to lower risk patient populations (class IIa, LoE B) with a known lower rate of complications and mortality 13 .…”

Novel self‐expanding ALLEGRA transcatheter aortic valve for native aortic stenosis and degenerated bioprosthesis

“…10 The hemodynamic outcome with a significant reduction in transvalvular mean gradients from 45.2 ± 13.0 to 8.2 ± 4.3 mmHg was at least in range of former reports on TAVR with supraanular design, if not even better. 20,21 Though, ViV-procedures in general lead to higher transvalvular gradients compared to TAVR procedures for native aortic stenosis. In our 15 ViV-cases with the ALLEGRA valve, the mean gradient by echocardiography could be decreased to 13.8 ± 6.3 mmHg.…”

The year 2021 in the European Heart Journal: Cardiovascular Imaging Part II

“…The present study describes normal values for all available TAVR prosthesis. 39 Another observational study explored followup parameters of 162 (79 Lotus and 83 SAPIEN3) consecutive patients. Authors are reporting that the frequency of mild (13.9% vs. 31.3%) and at least moderate (1.3% vs. 3.6%) paravalvular aortic regurgitation was less frequently found after Lotus than after SAPIEN3 implantation (P=0.02).…”