title: Intracardiac echocardiography: a new guiding tool for transcatheter aortic valve replacement.
abstract: BACKGROUND
  Echocardiography has been debated as an adjunct for transcatheter aortic valve replacement (TAVR). The aim of this prospective study was to comparatively evaluate intraprocedural guidance using intracardiac echocardiography (ICE) and transesophageal echocardiography (TEE).
  
  
  METHODS
  Fifty high-risk patients with severe aortic stenosis scheduled for TAVR were randomized to either guidance using ICE (group 1; n = 25) or monitoring using TEE (group 2; n = 25).
  
  
  RESULTS
  In contrast to TEE, ICE allowed continuous monitoring. The need for probe repositioning during the procedure was much lower in group 1 (0.1 ± 0.3 vs 5.7 ± 0.7 maneuvers, P < .001). Compared with TEE, the transcaval intracardiac echocardiographic view provided higher coaxiality with the ascending aorta expressed as the length of ascending aorta depicted (4.9 ± 1.2 vs 6.1 ± 1.2 cm, P = .003). Both coronary ostia were more frequently visualized in group 1 (18 vs 2 cases, P < .001). ICE-derived annular measurements were correlated closely with preinterventional readings on TEE (n = 25, r(2) = 0.90, P < .001). TEE underestimated intraprocedural pressure gradients in comparison with preinterventional measurements (mean difference, -10.2 ± 11.1 mm Hg; n = 11, P = .012), but ICE did not (mean difference, -0.3 ± 14.1 mm Hg; n = 25, P = .913). ICE and TEE detected newly grown thrombi (2 vs 1 case). Severe complications (e.g., annular dissection, pericardial effusion) were not observed.
  
  
  CONCLUSIONS
  ICE, which is compatible with sedation and local anesthesia, can be considered an alternative to TEE for intraprocedural guidance during TAVR. It also seems to match the required work flow during TAVR better than TEE.
authors.affiliation: Division of Cardiology, Department of Internal Medicine III, Medical University Innsbruck, Innsbruck, Austria.
authors.forename: Thomas
authors.initials: T
authors.lastname: Bartel
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Bonaros
authors.forename: Ludwig
authors.initials: L
authors.lastname: Müller
authors.forename: Guy
authors.initials: G
authors.lastname: Friedrich
authors.forename: Michael
authors.initials: M
authors.lastname: Grimm
authors.forename: Corinna
authors.initials: C
authors.lastname: Velik-Salchner
authors.forename: Gudrun
authors.initials: G
authors.lastname: Feuchtner
authors.forename: Florian
authors.initials: F
authors.lastname: Pedross
authors.forename: Silvana
authors.initials: S
authors.lastname: Müller
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D006328:Cardiac Catheterization; D004452:Echocardiography / Q000379:methods*; D017548:Echocardiography, Transesophageal; D005260:Female; D005500:Follow-Up Studies; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000379:methods*; D011446:Prospective Studies; D012372:ROC Curve; D015203:Reproducibility of Results; D012720:Severity of Illness Index; D013318:Stroke Volume; D018084:Ultrasonography, Interventional / Q000379:methods*; D016277:Ventricular Function, Left