title: Contrast echocardiography: a novel technique for assessment of total aortic regurgitation following transapical aortic valve implantation.
abstract: OBJECTIVE
  Aortic regurgitation (AR) is a possible complication following transcatheter aortic valve implantation (TAVI) which is associated with less-favourable outcomes. Quantification of total regurgitation caused by multiple, multidirectional jets remains controversial. The purpose of this study was to assess the usefulness of retrograde contrast echocardiography in quantification of total AR following TAVI and to evaluate its prognostic significance.
  
  
  METHODS
  In 245 patients following Edwards Sapien valve (Edwards Lifesciences, Irvine, CA, USA) implantation, we performed retrograde contrast transoesophageal echocardiography to quantify AR immediately after TAVI. The contrast (20 ml agitated gelatine polysuccinate, Gelafundin 4%, Braun, Melsungen, Germany) was injected as a bolus into the sinotubular junction of the aorta through a pigtail catheter. We measured the area of the regurgitant cloud during mid- to end-diastole. A regurgitant area of ≥3.8 cm2 was determined as an indicator of relevant AR. Sensitivity of this was compared through angiography and Doppler echocardiography. To assess whether AR identified by this novel method independently determined survival, a multivariate model was applied.
  
  
  RESULTS
  Angiography, Doppler echocardiography and contrast echocardiography recognized 15, 23 and 56 patients with relevant regurgitation. Multivariate analysis including a regurgitant area of ≥3.8 cm2, New York Heart Association (NYHA) class IV, age and creatinine concentration identified a regurgitant area of ≥3.8 cm2 (P=0.027) as independent risk factor for 2-year survival.
  
  
  CONCLUSIONS
  Contrast echocardiography is a simple method for quantification of total AR following TAVI and is more sensitive than angiography or Doppler echocardiography. Its clinical relevance is demonstrated by the impact of the AR detected by contrast echocardiography on survival.
authors.affiliation: Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany kukucka@dhzb.de.
authors.forename: Marian
authors.initials: M
authors.lastname: Kukucka
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Miralem
authors.initials: M
authors.lastname: Pasic
authors.affiliation: Institute of Physiology, Charité, Berlin, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Habazettl
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Unbehaun
authors.affiliation: Department of Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Dreysse
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Drews
authors.affiliation: Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Hillebrandt
authors.affiliation: Department of Anaesthesiology, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Mladenow
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany.
authors.forename: Semih
authors.initials: S
authors.lastname: Buz
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000601:surgery*; D001022:Aortic Valve Insufficiency / Q000175:diagnosis / Q000000981:diagnostic imaging* / Q000209:etiology / Q000401:mortality; D003287:Contrast Media; D004452:Echocardiography / Q000379:methods*; D018618:Echocardiography, Doppler, Color / Q000379:methods; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000379:methods / Q000401:mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis
chemical_list: D003287:Contrast Media
keywords: Aortic regurgitation; Contrast echocardiography; Survival; Transcatheter aortic valve implantation