title: Geometric changes in ventriculoaortic complex after transcatheter aortic valve replacement and its association with post-procedural prosthesis-patient mismatch: an intraprocedural 3D-TEE study.
abstract: OBJECTIVE
  Prosthesis-patient mismatch (PPM) after transcatheter aortic valve replacement (TAVR) leads to increased mortality. However, its peri-procedural determinants remain unknown. We investigated geometric changes in aortic annulus (AoA) and left ventricular outflow tract (LVOT) during TAVR by three-dimensional transoesophageal echocardiography (3D-TEE) and its association with post-procedural PPM.
  
  
  RESULTS
  A total of 131 patients with severe aortic stenosis underwent intraprocedural 3D-TEE during balloon-expandable TAVR. The severity of PPM was graded using the indexed effective orifice area calculated by Doppler echocardiography at discharge, with moderate defined as ≥0.65 and ≤0.85 cm2/m2and severe defined as <0.65 cm2/m2. 3D planimetered AoA area decreased after TAVR (P< 0.001), whereas the LVOT increased (P= 0.004). The eccentricity of both AoA and LVOT decreased after TAVR (both, P< 0.001). At discharge, the incidence of overall and severe PPM was 44 and 12%, respectively. Patients with PPM had a larger body surface area, smaller aortic valve area, and less frequent balloon dilation (all P< 0.05). Patients with PPM had a lower post-TAVR AoA area/pre-TAVR AoA area (91 ± 8 vs. 95 ± 7%, P= 0.001) than those without PPM. The post-TAVR AoA area/pre-TAVR AoA area was independently associated with overall PPM (odds ratio, 1.80; 95% CI, 1.06-3.05; P= 0.031) and severe PPM (odds ratio, 2.50; 95% CI, 1.05-5.36; P= 0.04). Additionally, a cut-off value of this ratio >86.3% had a sensitivity of 84% and a specificity of 44% for the prevention of severe PPM.
  
  
  CONCLUSIONS
  3D-TEE can evaluate geometric changes in AoA and LVOT during balloon-expandable TAVR and predicts post-procedural PPM.
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
authors.forename: Hiroto
authors.initials: H
authors.lastname: Utsunomiya
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
authors.forename: Hirotsugu
authors.initials: H
authors.lastname: Mihara
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
authors.forename: Yuji
authors.initials: Y
authors.lastname: Itabashi
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
authors.forename: Sayuki
authors.initials: S
authors.lastname: Kobayashi
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.|University of California, Los Angeles, CA, USA.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
authors.forename: Tarun
authors.initials: T
authors.lastname: Chakravarty
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
authors.forename: Hasan
authors.initials: H
authors.lastname: Jilaihawi
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA.
authors.forename: Raj R
authors.initials: RR
authors.lastname: Makkar
authors.affiliation: Cedars-Sinai Heart Institute, Cedars-Sinai Medical Center, 127 South San Vicente Boulevard A3411, Los Angeles, CA 90048, USA shiotat@cshs.org.|University of California, Los Angeles, CA, USA.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
mesh_terms: D000367:Age Factors; D000368:Aged; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000628:therapy*; D001705:Bioprosthesis; D015331:Cohort Studies; D004452:Echocardiography; D019560:Echocardiography, Three-Dimensional; D005260:Female; D006350:Heart Valve Prosthesis / Q000009:adverse effects*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D011474:Prosthesis Design; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D015996:Survival Rate; D065467:Transcatheter Aortic Valve Replacement / Q000009:adverse effects* / Q000379:methods
keywords: prosthesis–patient mismatch; three-dimensional transoesophageal echocardiography; transcatheter aortic valve replacement