title: Intraoperative 2D and 3D transoesophageal echocardiographic predictors of aortic regurgitation after transcatheter aortic valve implantation.
abstract: BACKGROUND
  Post-procedural aortic regurgitation (AR) has been described in a large number of patients receiving transcatheter aortic valve implantation (TAVI).
  
  
  OBJECTIVE
  The aim of this study was to examine the intraoperative 2-dimensional (2D) and 3-dimensional (3D) echocardiographic features of the aortic valve associated with significant post-procedural paravalvular AR.
  
  
  METHODS
  A total of 135 patients (81±7 years) with severe symptomatic aortic stenosis, who underwent TAVI, were imaged with comprehensive 2D and 3D transoesophageal echocardiography before the procedure and peri-procedure. Various baseline and peri-procedural echocardiographic characteristics were tested to predict paravalvular AR post-TAVI: calcifications at the aortic valve commissures and leaflets, 'aortic annulus eccentricity index', 'area cover index', overlap between aortic prosthesis and anterior mitral leaflet. Post-procedural paravalvular AR≥2 was considered significant.
  
  
  RESULTS
  Successful TAVI was achieved in all patients. The incidence of paravalvular AR≥2 immediately after the procedure was 21% (28 patients). Commissural calcifications and, particularly, the calcification of the commissure between the right coronary and non-coronary cusps was significantly more frequent in presence of paravalvular AR; the area cover index pre-TAVI was significantly lower among patients with AR (11.1±11.8% vs 20.8±12.5%, p=0.0004). Multivariate analysis revealed that calcification of the commissure between the right coronary and non-coronary cusps (OR=2.66, 95% CI 1.39 to 5.12, p=0.001), and the area cover index pre-TAVI (OR=0.95, 95% CI 0.91 to 0.99, p=0.006) were the only independent predictors of significant paravalvular AR after TAVI.
  
  
  CONCLUSIONS
  Intraoperative 2D and 3D transoesophageal echocardiography identified calcification of the commissure between the right coronary and non-coronary cusps and the area cover index as independent predictors of significant paravalvular AR following TAVI.
authors: Centro Cardiologico Monzino, IRCCS, Milano, Italy. paola.gripari@ccfm.it
authors: Paola
authors: P
authors: Gripari
authors: See Hooi
authors: SH
authors: Ewe
authors: Laura
authors: L
authors: Fusini
authors: Manuela
authors: M
authors: Muratori
authors: Arnold C T
authors: AC
authors: Ng
authors: Claudia
authors: C
authors: Cefalù
authors: Victoria
authors: V
authors: Delgado
authors: Martin J
authors: MJ
authors: Schalij
authors: Jeroen J
authors: JJ
authors: Bax
authors: Nina Ajmone
authors: NA
authors: Marsan
authors: Gloria
authors: G
authors: Tamborini
authors: Mauro
authors: M
authors: Pepi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology; D001024:Aortic Valve Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000628:therapy*; D002114:Calcinosis / Q000150:complications; D006328:Cardiac Catheterization / Q000009:adverse effects*; D016009:Chi-Square Distribution; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods; D006801:Humans; D015994:Incidence; D007558:Italy; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D009426:Netherlands; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors