title: 3D Assessment of Features Associated With Transvalvular Aortic Regurgitation After TAVR: A Real-Time 3D TEE Study.
abstract: OBJECTIVE
  This study of 3-dimensional (3D) transesophageal echocardiography (TEE) aimed to demonstrate features associated with transvalvular aortic regurgitation (AR) after transcatheter aortic valve replacement (TAVR) and to confirm the fact that a gap between the native aortic annulus and prosthesis is associated with paravalvular AR.
  
  
  BACKGROUND
  The mechanism of AR after TAVR, particularly that of transvalvular AR, has not been evaluated adequately.
  
  
  METHODS
  All patients with severe aortic stenosis who underwent TAVR with the Sapien device (Edwards Lifesciences, Irvine, California) had 3D TEE of the pre-procedural native aortic annulus and the post-procedural prosthetic valve.
  
  
  RESULTS
  In the 201 patients studied, the total AR was mild in 67 patients (33%), moderate in 21 patients (10%), and severe in no patients. There were 20 patients with transvalvular AR and 82 patients with paravalvular AR. Fourteen patients had both transvalvular and paravalvular AR. Patients with transvalvular AR had larger prosthetic expansion (p <0.05), a more elliptical prosthetic shape at the prosthetic commissure level (p <0.01) and more anti-anatomical position (p <0.001), which was defined as malposition of the prosthetic commissures in relation to the native commissures, than the patients without transvalvular AR. Age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.01 to 1.09; p < 0.05) and effective area oversizing (OR: 0.97; 95% CI: 0.93 to 0.99, p <0.05) were associated with mild or greater paravalvular AR.
  
  
  CONCLUSIONS
  3D TEE successfully demonstrated the features associated with transvalvular AR, such as large prosthetic expansion, elliptical prosthetic shape, and anti-anatomical position of prosthesis. Additionally, effective area oversizing was associated with paravalvular AR.
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California; Heart Center, Tokyo Bay Urayasu/Ichikawa Medical Center, Urayasu, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Shibayama
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Mihara
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Javier
authors.initials: J
authors.lastname: Berdejo
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Kenji
authors.initials: K
authors.lastname: Harada
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Itabashi
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California; University of California, Los Angeles, Los Angles, California.
authors.forename: Robert
authors.initials: R
authors.lastname: Siegel
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
authors.affiliation: Cedars-Sinai Heart Institute, Los Angeles, California; University of California, Los Angeles, Los Angles, California. Electronic address: ShiotaT@cshs.org.
authors.forename: Takahiro
authors.initials: T
authors.lastname: 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; D006328:Cardiac Catheterization / Q000009:adverse effects* / Q000295:instrumentation; D016009:Chi-Square Distribution; D018618:Echocardiography, Doppler, Color; D019560:Echocardiography, Three-Dimensional; D017548:Echocardiography, Transesophageal; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation; D006801:Humans; D016015:Logistic Models; D008297:Male; D015999:Multivariate Analysis; D015588:Observer Variation; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011474:Prosthesis Design; D011475:Prosthesis Failure; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D016896:Treatment Outcome
keywords: aortic valve; aortic valve insufficiency; echocardiography