Doppler haemodynamics and effective orifice areas of Edwards SAPIEN and CoreValve transcatheter aortic valves.
OBJECTIVE
Transcatheter aortic valve implantation (TAVI) is a new therapy for severe aortic stenosis in high-risk patients. So far, no reference values for the echocardiographic assessment of this new class of heart valves have been established. The aim of our study was to determine Doppler haemodynamics and the effective orifice area (EOA).


RESULTS
We retrospectively analysed the earliest transthoracic echocardiographic examinations of 146 stable patients after successful TAVI (median 8±20 days). Doppler examinations were analysed for peak instantaneous velocity, peak, and the mean systolic gradient. EOA was determined using the continuity equation. Patients with severe paravalvular aortic or mitral valve regurgitation were excluded. The overall peak instantaneous velocity (n=146) was 2.0±0.4 m/s with a peak systolic gradient of 17.1±7.4 mmHg and a mean gradient of 9.3±4.5 mmHg. The mean EOA was 1.82±0.43 cm2 with an indexed EOA of 1.0±0.27 cm2/m2. In general, all prostheses showed similar values-with the exception of the Edwards Sapien 23 mm which was associated with higher velocities and peak pressure gradients.


CONCLUSIONS
Our study establishes the normal range for Doppler haemodynamics of four transcatheter aortic valve prostheses. Compared with previously published data of surgically implanted bioprostheses percutaneous valves tend to have similar EOA values but lower mean peak velocities and pressure gradients. In comparison with physiological haemodynamics; however, this new class of heart valves is still associated with a mild obstruction.
Charité Campus Mitte, Universitätsmedizin, Charitéplatz 1, D-10117 Berlin, Germany. sebastian.spethmann@charite.de
Sebastian
S
Spethmann
Henryk
H
Dreger
Sebastian
S
Schattke
Gerd
G
Baldenhofer
Davit
D
Saghabalyan
Verena
V
Stangl
Michael
M
Laule
Gert
G
Baumann
Karl
K
Stangl
Fabian
F
Knebel
D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery*; D001705:Bioprosthesis; D015150:Echocardiography, Doppler; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome