Post/preprocedural ratio of hemodynamically assessed aortic regurgitation index as a marker for the need for corrective measures during transcatheter valve replacement: A first confirmatory study in patients receiving a new generation transcatheter self‐expandable prosthesis

Abstract

Objectives We aimed to investigate the value of post/preprocedural aortic regurgitation index (ARI) ratio as a marker for more‐than‐mild aortic regurgitation (AR) after transcatheter aortic valve replacement (TAVR) and as an indication of the need for corrective measures, provided that the implantation depth was acceptable. Background Post/preprocedural ARI increases accuracy of residual AR assessment by considering hemodynamic status prior to TAVR. Methods ARI ratio was calculated in 70 patients undergoing TAVR. ARI ratios were defined as post/preprocedural ARI (ARI ratio 1), and as postcorrective measure/preprocedural ARI (ARI ratio 2). Intraprocedurally, corrective measures use was decided based on angiographically assessed AR severity. The relationship of such decisions to ARI ratios based on a recently proposed threshold (ARI ratio < 0.6) was evaluated. ARI ratios in corrected versus noncorrected patients and precorrection versus postcorrection values were assessed. Results Overall, mean (±SD) ARI ratio 1 (n = 70) was 0.81 (±0.36). Corrective measures were used in 22 patients (31.4%). Mean ARI ratio 1 in such patients was 0.55 (±0.25) versus 0.93 (±0.34) in the 48 noncorrected patients (P < 0.0001). Mean ARI ratio 1 in 21 patients requiring postdilation was 0.56 (±0.25), which was below the previously suggested 0.6 threshold. After postdilation, ARI ratio 2 increased to 0.85 (±0.16) (P < 0.0001), with all patients showing an ARI ratio 2 ≥ 0.6. Conclusions ARI ratio is closely related to intraprocedural decisions to perform corrective measures based on angiography. Routine use of intraprocedural ARI ratio could be useful as a complementary quantitative marker for residual AR and for the need for corrective measures.

Value of Post-/Pre-Procedural Aortic Regurgitation Ratio vs. Pre-Procedural Aortic Valve Calcium Score to Predict Moderate to Severe Paravalvular Leak Requiring Post-Dilation after Transcatheter Aortic Valve Implantation

“…As expected, the ARI ratio values were significantly lower in patients who underwent PD: 0.61 (0.49-0.80) vs. 0.82 (0.69-0.99) (p < 0.001). When using the previously established ARI ratio threshold [14,15], a significantly higher frequency of patients who underwent corrective interventions showed an ARI ratio < 0.6 (49.2% vs. 13.4%, p < 0.001). Further detailed hemodynamic measurements are shown in Table 4.…”

Sex‐Specific Considerations in Degenerative Aortic Stenosis for Female‐Tailored Transfemoral Aortic Valve Implantation Management

“… Intra‐ or paravalvular leak has to be accurately detected by multimodality evaluation (including supraortic angiogram, intraprocedural echocardiogram evaluation, aortic and left ventricle invasive pressure measurements, aortic regurgitation index) to try to optimize the result by means of adjunctive maneuvers (ie, after dilatation). 77 The use of the dicrotic notch index to assess for paravalvular leak avoiding left ventricle measurements is currently under investigation. 44 …”