140 Impact of TAVI with the Edwards-SAPIEN endoprosthesis on mitral regurgitation: results of a serial echocardiography assessment

PurposeThe impact of transcatheter aortic valve implantation (TAVI) on mitral regurgitation (MR) is controversial. Two recent publications have reported improvement in MR grades following implantation of the Edwards-SAPIEN endoprosthesis. These findings were not replicated with the Core-Valve. The time course of improvement in MR grades with the Edwards-SAPIEN valve has not been described on an individual patient basis and the potential mechanisms of benefit are unclear. The aim of this study was to assess the acute and intermediate changes in MR severity after TAVI with the Edwards-SAPIEN endoprosthesis.MethodsEchocardiography was performed in 22 consecutive patients before and after treatment, and at 1 month follow-up. MR was assessed by color flow mapping and was graded as none, mild, moderate, or severe. MR was defined as organic or functional.ResultsThe aortic valve area increased from pretreatment 0.72cm2 to post-treatment 1.87cm2 and postdischarge 1.81cm2 (P<0.0001). Before intervention MR was present in 73% of the patients. It was mild, moderate, or severe in 36% (n=8), 32% (n=7), and 4% (n=1) respectively. MR was defined as organic in 6 patients (27%) and functional in 10 patients (45%). Compared to baseline, MR grades improved by 1 month (p for trend=0.01). This benefit was secondary to a reduction in regurgitation grades in 50% of patients with an MR at baseline (n=6), while no worsening was observed in the other patients with an MR (n=6) and no occurrence of MR was observed in patients without MR (n=6). A trend for a greater improvement in MR grade was observed in patients with functional MR (n=7, − 1.00) compared to those with an organic MR (n=5, − 0.294; p=0.10).ConclusionIn consecutive patients with a successful implantation of an Edwards-SAPIEN valve a significant improvement in MR was observed. This benefit was secondary to an improvement in 50% of patients with an MR and no worsening in the others

Automated 3D Analysis of Pre-Procedural MDCT to Predict Annulus Plane Angulation and C-Arm Positioning Benefit on Procedural Outcome in Patients Referred for TAVR

<p>OBJECTIVES The aim of this study was to determine whether pre-procedural analysis of multidetector row computed tomography (MDCT) scans could accurately predict the "line of perpendicularity" (LP) of the aortic annulus and corresponding C-arm angulations required for prosthesis delivery and impact the outcome of the procedure.</p><p>BACKGROUND Optimal positioning of the transcatheter aortic prosthesis is paramount to transcatheter aortic valve replacement (TAVR) procedural success.</p><p>METHODS All patients referred for TAVR at our center underwent a routine pre-procedural MDCT scan. A 3-dimensional (3D) analysis using software dedicated to define the LP of the aortic annulus and the corresponding C-arm positioning was performed in 71 consecutive patients. In 35 patients, the results of the MDCT analysis were not available at the time of the procedure (angiography cohort). In that cohort the position of the C-arm was determined during the procedure using ad-hoc angiography. In 36 patients, the MDCT analysis was performed pre-procedure and results were available at the time of the procedure (MDCT cohort). In that cohort the position of the C-arm was derived from the MDCT analysis rather than by ad-hoc angiography.</p><p>RESULTS Intraobserver and interobserver reproducibility of MDCT analysis to predict the LP of the aortic annulus were excellent (kappa = 1 and 0.94, respectively). Patient variations of the LP ranged >70 degrees. Compared with the angiography cohort, the MDCT cohort was associated with a significant decrease in implantation time (p = 0.0001), radiation exposure (p = 0.02), amount of contrast (p = 0.001), and risk of acute kidney injury (p = 0.03). Additionally, the combined rate of valve malposition and aortic regurgitation was also reduced (6% vs. 23%, p = 0.03).</p><p>CONCLUSIONS Automated 3D analysis of pre-implantation MDCT accurately predicts the LP of the aortic annulus and the corresponding C-arm position required for TAVR. With this approach, the implantation of the balloon-expandable prosthetic valve can be performed without an aortogram in the majority of cases and still be safe, with a low rate of valve malpositioning and regurgitation. (J Am Coll Cardiol Img 2013;6:238-48) (C) 2013 by the American College of Cardiology Foundation</p>