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DOI: 10.1055/s-0029-1191519
Transcather aortic valve implantation supported by 3D trans-esophageal echocardiography: Should it become the standard?
Objectives: Transcather aortic valve implantation (TAVI) is an alternative option for aortic valve replacement. Various potential risks such as trauma to the aortic root (˜2%), coronary complications (˜4%), valve displacement/embolisation (˜5%), aortic regurgitation ≥2 (˜7%), use of cardiopulmonary bypass (˜32%) and conversion to open surgery (˜6%) have been reported previously. 3D Trans-esophageal echocardiography (3D-TEE) has recently been shown to provide additional information of the aortic valve/root morphology. We present our TAVI experience assisted with 3D-TEE.
Methods: A total of 29 patients underwent TAVI (17 transapical and 12 transfemoral) using the Edwards Lifesciences Ascendra® and Retroflex® delivery systems at our institution (mean age 86 y, female n=15, mean Euroscore 19.4%, porcelain aorta n=6). The implantations were performed using fluoroscopy, assisted by 3D-TEE.
Results: All valves were successfully implanted, with no incidence of aortic root injury, coronary complication, valve displacement/embolisation or conversion to open surgery. Aortic regurgitation of ≥ grade 2 occurred in 1/29 patients (3%) and one required support using cardiopulmonary bypass (3%). In hospital/30 day mortality was 11%. No valve related death or myocardial infarct was observed.
Conclusions: Therefore we hypothesise that the use of 3D-TEE during TAVI makes balloon and valve positioning during deployment more feasible and reduces the incidence of peri-procedure complications such as wire entrapment and incomplete deployment of the prosthesis. In addition it may lead to decreased fluoroscopy and hence use of contrast medium.