Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve Function

Rebecca T Hahn; Jonathon Leipsic; Pamela S Douglas; Wael A Jaber; Neil J Weissman; Philippe Pibarot; Philipp Blanke; Jae K Oh

doi:10.1016/j.jcmg.2018.04.010

Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve Function

JACC Cardiovasc Imaging. 2019 Jan;12(1):25-34. doi: 10.1016/j.jcmg.2018.04.010. Epub 2018 Jun 13.

Authors

Rebecca T Hahn¹, Jonathon Leipsic², Pamela S Douglas³, Wael A Jaber⁴, Neil J Weissman⁵, Philippe Pibarot⁶, Philipp Blanke², Jae K Oh⁷

Affiliations

¹ Columbia University Medical Center/New York-Presbyterian Hospital, New York, New York. Electronic address: rth2@columbia.edu.
² University of British Columbia and St. Paul's Hospital, Vancouver, Canada.
³ Division of Cardiovascular Medicine, Duke University Medical Center, and Duke Clinical Research Institute, Durham, North Carolina.
⁴ Cleveland Clinic Foundation, Cleveland, Ohio.
⁵ Medstar Health Research Institute, Washington, DC.
⁶ Institut Universitaire de Cardiologie et de Pneumologie de Québec/Québec Heart & Lung Institute, Department of Medicine, Laval University, Québec, Canada.
⁷ Mayo Clinic, Rochester, Minnesota.

PMID: 29909110
DOI: 10.1016/j.jcmg.2018.04.010

Abstract

Objectives: This study aims to establish parameters for identifying normal function for each of the 3 iterations of balloon-expandable valves and 2 iterations of self-expanding valves.

Background: Expected transthoracic echocardiographic Doppler-derived hemodynamic data for transcatheter aortic valves inform pre-implant decision-making and post-implanted monitoring of longitudinal valve function.

Methods: We collected the echocardiography core Lab measured mean gradients and effective orifice area (EOA) from discharge or 30-day echocardiograms from randomized trials; the PARTNER (Placement of Aortic Transcatheter Valves) trials for the balloon-expandable valves and the Medtronic CoreValve US Pivotal trial and Medtronic CoreValve Evolut R United States IDE Clinical Study for the self-expanding valves.

Results: For all SAPIEN (Edwards Lifesciences, Irvine, California) valve sizes, mean EOA is 1.70 ± 0.49 cm² with a mean gradient of 9.36 ± 4.13 mm Hg. For all SAPIEN XT valve sizes, mean EOA is 1.67 ± 0.46 cm² with a mean gradient of 9.52 ± 3.64 mm Hg. For all SAPIEN 3 valve sizes, the mean EOA is 1.66 ± 0.38 cm² with a mean gradient of 11.18 ± 4.35 mm Hg. For all CoreValve valve sizes, the mean EOA is 1.88 ± 0.56 cm² with a mean gradient of 8.85 ± 4.14 mm Hg. For all Evolut R valve sizes, the mean EOA is 2.01 ± 0.65 cm² with a mean gradient of 7.52 ± 3.19 mm Hg. The SAPIEN 3 post-implant EOA was progressively larger for each quintile of baseline annular area by computed tomography (p < 0.001). Similarly, for the Evolut R valve, post-implantation EOA was significantly larger for each quintile of baseline annular perimeter (p < 0.001).

Conclusions: Tables of expected mean transcatheter aortic valve hemodynamics by valve type and size are essential in evaluating the function of these transcatheter prosthetic valves. Tables of expected EOA by the native annular anatomy may be useful for pre-implantation decision making. Criteria for defining structural valve dysfunction are proposed.

Keywords: echocardiography; effective orifice area; hemodynamics; transcatheter aortic valve replacement.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aortic Valve / diagnostic imaging*
Aortic Valve / physiopathology
Aortic Valve / surgery*
Aortic Valve Stenosis / diagnostic imaging*
Aortic Valve Stenosis / physiopathology
Aortic Valve Stenosis / surgery*
Balloon Valvuloplasty
Bioprosthesis*
Echocardiography, Doppler*
Heart Valve Prosthesis*
Hemodynamics*
Humans
Multidetector Computed Tomography
Predictive Value of Tests
Prosthesis Design
Randomized Controlled Trials as Topic
Recovery of Function
Registries
Time Factors
Transcatheter Aortic Valve Replacement / adverse effects
Transcatheter Aortic Valve Replacement / instrumentation*
Treatment Outcome