Pre-Procedural Hemodynamic Status Improves the Discriminatory Value of the Aortic Regurgitation Index in Patients Undergoing Transcatheter Aortic Valve Replacement

Sinning, Jan‐Malte; Stundl, Anja; Pingel, Simon; Weber, Marcel; Sedaghat, Alexander; Hammerstingl, Christoph; Vasa‐Nicotera, Mariuca; Mellert, Fritz; Schiller, Wolfgang; Kováč, Ján; Welz, Armin; Grube, Eberhard; Werner, Nikos; Nickenig, Georg

doi:10.1016/j.jcin.2015.12.271

Cited by 35 publications

(41 citation statements)

References 31 publications

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“…The ARI is a useful parameter to identify the need of PD but also to quantify the success of PD (additionally to imaging modalities) [9,15]. Moreover, recently Sinning et al [27] have shown that ARI integrating pre-and post-procedural haemodynamic status increases the discriminatory value of post-procedural ARI and is useful to identify patients with unfavourable prognosis. The difference in radiation dose, fluoroscopy time, and contrast load between patients with and without PD may be caused by some differences in baseline characteristics and more frequent use of the transapical approach in the PD (+) group.…”

Section: Discussionmentioning

confidence: 99%

Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation

Kleczyński¹,

Dziewierz²,

Daniec³

et al. 2017

Kardiol Pol

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A b s t r a c tBackground: Post-implantation paravalvular leak (PVL) remains a significant complication of transcatheter aortic valve implantation (TAVI). More importantly, its occurrence may impact long-term mortality. Aim:We sought to evaluate the effects of balloon post-dilatation (PD) on the reduction of PVL and mortality in patients undergoing TAVI.Methods: A total of 101 consecutive patients undergoing TAVI were enrolled. Angiography, echocardiography, and the aortic regurgitation index (ARI) were used to assess the severity of PVL before and after balloon PD. Patients were divided into two groups based whether or not PD after TAVI was performed. Reduction of PVL, change of ARI, and clinical outcomes were assessed.Results: Balloon post-dilatation was performed in 23 (22.8%) patients. In 95.6%, PVL reduction was successful (no or mild PVL). PD increased the ARI from 23.4% (22.4-24.0) to 27.1% (26.1-28.3); p < 0.001. Thirty-day mortality rate was 14.1% in the PD (-) group vs. 0.0% in the PD (+) group; p = 0.07. One-year mortality (21.8% vs. 4.3%, p = 0.97) and procedural stroke rate (7.7% vs. 8.7%, p = 0.99) were not different between the groups. Conclusions:Balloon post-dilatation may be a safe and effective technique to reduce moderate to severe PVL after TAVI.

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Section: Discussionmentioning

confidence: 99%

Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation

Kleczyński¹,

Dziewierz²,

Daniec³

et al. 2017

Kardiol Pol

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“…Performance of a recently proposed ARI ratio threshold (ARI ratio < 0.6) to predict intraprocedural corrective decisions based on angiography was described.…”

Section: Methodsmentioning

confidence: 99%

“…To reduce angiography observer‐dependency, simple reproducible hemodynamic parameters have been developed as standardized quantitative tools to assess residual AR after TAVR …”

Section: Introductionmentioning

confidence: 99%

“…Early findings suggest that adding preintervention hemodynamic data could improve our capacity to predict the need for corrective measures and to discern whether or not a treated patient is able to tolerate the resulting change in his/her baseline hemodynamics, for example in a patient with previous diastolic dysfunction. According to Sinning et al, ARI ratio 1 ≥ 0.6 indicates a satisfactory result regarding residual AR, implying no increase in mortality . In contrast, ARI ratio 1 < 0.6 usually suggests a moderate‐to‐severe AR resulting in adverse outcomes …”

Section: Introductionmentioning

confidence: 99%

“…According to Sinning et al, ARI ratio 1 ≥ 0.6 indicates a satisfactory result regarding residual AR, implying no increase in mortality . In contrast, ARI ratio 1 < 0.6 usually suggests a moderate‐to‐severe AR resulting in adverse outcomes …”

Section: Introductionmentioning

confidence: 99%

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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

Mas-Peiró

Weiler

Papadopoulos

et al. 2018

Cathet Cardio Intervent

Self Cite

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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.

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Paravalvular Leaks

Ooms

Rahhab

Mieghem

2021

Aortic Valve Transcatheter Intervention

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Pre-Procedural Hemodynamic Status Improves the Discriminatory Value of the Aortic Regurgitation Index in Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract: The ARI ratio integrating pre- and post-procedural hemodynamic status increases the discriminatory value of post-procedural ARI. The ARI ratio, which reflects acute hemodynamic changes after TAVR, is useful to identify patients with negative outcomes.

Cited by 35 publications

References 31 publications

Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation

Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation

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

Paravalvular Leaks

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