title: Assessment of Post-Procedural Aortic Regurgitation After TAVR: An Intraprocedural TEE Study.
abstract: OBJECTIVE
  The purpose of this study was to determine which echocardiographic parameters, including holodiastolic flow reversal (HDFR) in the descending aorta, were useful for grading of post-procedural aortic regurgitation (PAR) after transcatheter aortic valve replacement (TAVR) using intraprocedural transesophageal echocardiography.
  
  
  BACKGROUND
  Reliable assessment of PAR in a catheterization laboratory is essential for an optimal outcome after TAVR; however, such an assessment has not been determined.
  
  
  METHODS
  Three hundred eighty patients who underwent TAVR with the Edwards (Irvine, California) balloon-expandable transcatheter heart valve were retrospectively assessed by intraprocedural transesophageal echocardiography. PAR was evaluated by 2-dimensional color Doppler and pulse-wave Doppler in the descending aorta. Using 2-dimensional color Doppler, we measured the cross-sectional area of the vena contracta, the circumferential extent at the aortic annular plane, the longitudinal jet length, and the jet extent (with a mosaic pattern in the left ventricular outflow tract) compared with the location of the tip of the anterior mitral leaflet (AML). Grading of PAR was determined using the following vena contracta cutoffs: mild ≤9 mm(2); moderate 10 to 29 mm(2); and severe ≥30 mm(2). Significant PAR was defined as at least moderate grade.
  
  
  RESULTS
  All patients with consistent HDFR had significant PAR. By multivariable analysis, consistent HDFR and the jet extent beyond the tip of AML were independent predictors of significant PAR. Consistent HDFR and jet extent beyond the tip of AML predicted significant PAR with specificities of 100% and 97%, respectively. In contrast, patients with both negative HDFR and a jet extent of less than halfway to the tip of AML had no significant PAR, with 97% specificity.
  
  
  CONCLUSIONS
  The presence of consistent HDFR and jet extent beyond the tip of AML are indicative of significant PAR after TAVR.
authors: Noninvasive Cardiac Laboratory, Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Hirotsugu
authors: H
authors: Mihara
authors: Noninvasive Cardiac Laboratory, Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Kentaro
authors: K
authors: Shibayama
authors: Noninvasive Cardiac Laboratory, Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Hasan
authors: H
authors: Jilaihawi
authors: Noninvasive Cardiac Laboratory, Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Yuji
authors: Y
authors: Itabashi
authors: Noninvasive Cardiac Laboratory, Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Javier
authors: J
authors: Berdejo
authors: Noninvasive Cardiac Laboratory, Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Hiroto
authors: H
authors: Utsunomiya
authors: Noninvasive Cardiac Laboratory, Cedars-Sinai Heart Institute, Los Angeles, California; University of California, Los Angeles, Los Angles, California.
authors: Robert J
authors: RJ
authors: Siegel
authors: Noninvasive Cardiac Laboratory, Cedars-Sinai Heart Institute, Los Angeles, California.
authors: Raj R
authors: RR
authors: Makkar
authors: Noninvasive Cardiac Laboratory, Cedars-Sinai Heart Institute, Los Angeles, California; University of California, Los Angeles, Los Angles, California. Electronic address: ShiotaT@cshs.org.
authors: Takahiro
authors: T
authors: Shiota
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001022:Aortic Valve Insufficiency / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D018619:Echocardiography, Doppler, Pulsed; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: aortic stenosis; paravalvular regurgitation; transcatheter aortic valve replacement; transesophageal echocardiography