The Role of Quantitative Aortographic Assessment of Aortic Regurgitation by Videodensitometry in the Guidance of Transcatheter Aortic Valve Implantation

Abstract

BackgroundBalloon post-dilatation (BPD) is often needed for optimizing transcatheter heart valve (THV) implantation, since paravalvular leak (PVL) after transcatheter aortic valve implantation is associated with poor outcome and mortality. Quantitative assessment of PVL severity before and after BPD is mandatory to properly assess PVL, thus improving implantation results and outcomes.ObjectiveTo investigate a quantitative angiographic assessment of aortic regurgitation (AR) by videodensitometry before and after BPD.MethodsVideodensitometric-AR assessments (VD-AR) before and after BPD were analysed in 61 cases.ResultsVD-AR decreased significantly from 24.0[18.0-30.5]% to 12.0[5.5-19.0]% (p < 0.001, a two-tailed p < 0.05 defined the statistical significance). The relative delta of VD-AR after BPD ranged from -100% (improvement) to +40% (deterioration) and its median value was -46.2%. The frequency of improvement, no change, and deterioration were 70% (n = 43), 25% (n = 15) and 5% (n = 3), respectively. Significant AR (VD-AR > 17%) was observed in 47 patients (77%) before and in 19 patients (31%) after BPD.ConclusionsVD-AR after THV implantation provides a quantitative assessment of post-TAVI regurgitation and can help in the decision-making process on performing BPD and in determining its efficacy.

Paravalvular Aortic Regurgitation Severity Assessed by Quantitative Aortography: ACURATE neo2 versus ACURATE neo Transcatheter Aortic Valve Implantation

“…Furthermore, the long-term vital prognostic value of a threshold of 17% in AR has been reported [12]. The improvement in AR following post-balloon dilatation has also been assessed with this technique, and its impact on long-term prognosis has been demonstrated [13].…”

Quantitative Angiographic Assessment of Aortic Regurgitation After Transcatheter Implantation of the Venus A-valve: Comparison with Other Self-Expanding Valves and Impact of a Learning Curve in a Single Chinese Center

“…Postimplantation balloon dilatation improvement in AR has also been quantitatively documented in a series of 61 patients [15]. Importantly, video densitometry-derived AR has proven to be a predictor of long-term prognosis after TAVR, with a >17 % threshold of AR identifying those at risk of long-term mortality [10,15]. The results of quantitative analyses of Evolut Pro, Evolut R, CoreValve (Medtronic, Dublin, Ireland), and Acurate Neo (Boston Scientific, Massachusetts, USA) were retrieved from a published pooled database [8].…”

“…It is similar to angiography and transesophageal echocardiography-guided procedures [19]. Based on the previous validation [8,13,14], quantitative aortographic assessment of AR has been shown to be an objective, accurate, and reproducible tool for assessment of AR following TAVR, and has the potential to facilitate timely decision-making to correct the AR with balloon post-dilatation, when additional corrective maneuvers are mandatory from a functional and prognostic perspective [15]. Conversely the online, objective and quantitative assessment also allows for the decision making to avert an unnecessary post-dilatation of the THVs that always entails the risk of a potential, manifest or silent, neurologic event.…”

“…Technical details of video densitometry analysis and validation in silico, in vivo, in animal models as well as in clinical correlations with magnetic resonance imaging, transthoracic and transesophageal echocardiography have been extensively reported in literature [10][11][12][13][14]. Postimplantation balloon dilatation improvement in AR has also been quantitatively documented in a series of 61 patients [15]. Importantly, video densitometry-derived AR has proven to be a predictor of long-term prognosis after TAVR, with a >17 % threshold of AR identifying those at risk of long-term mortality [10,15].…”

The Year in Cardiology 2018: ABC Cardiol and RPC at a glance

“…Several studies have shown that left atrium (LA) size and function are important predictors of cardiovascular events in several clinical settings and can be involved in the progression to heart failure. 51-52 In another interesting article published in Rev Port Cardiol, Fontes-Carvalho et al 53 evaluated in 94 patients after AMI the role of different indices of LA function (assessed by speckle tracking) as determinants of exercise capacity by cardiopulmonary exercise testing. They found a significant correlation between exercise capacity and LA conduit function, but not with contractile function.…”