Immediate and Long-Term Echocardiographic Findings after Transcatheter Aortic Valve Implantation for the Treatment of Aortic Stenosis: The Cribier-Edwards/Edwards-Sapien Valve Experience

Background

The role of transcatheter aortic valve implantation in the treatment of calcific aortic stenosis is evolving. Immediate and long-term echocardiographic findings are poorly reported.

Methods

Eighty-eight patients in whom surgical aortic valve replacement was contraindicated were studied before and 1 and 7 days, 1 month, and 1 and 2 years after the transcatheter procedure by echocardiography for hemodynamic. Transaortic pressure gradient, permeability index, and aortic valve area were measured, and aortic regurgitation was estimated from a multiparametric approach. A subset group of 36 patients (23-mm valve, n = 18; 26-mm valve, n = 18) with optimal ultrasound window were investigated for valve geometry at 7 days. We measured the sphericity index (anteroposterior to sagittal diameter ratio) and the angulation of the prosthesis with the ascending aorta.

Results

By analysis of variance, transaortic pressure gradient significantly decreased and aortic valve area increased after the procedure (P < .0001 and P < .0001 respectively). Aortic regurgitation severity tended to decline at follow-up (P = .20) and was unaffected by valve size (P = .35). Leaks were paraprosthetic in 77% of cases, intraprosthetic in 6% of cases, and both in 17% of cases. Overall, the sphericity index was 1.03 ± 0.07 and the angulation was 2.9 ± 1.1 degrees.

Conclusion

Echocardiography aids in the demonstration of appropriate prosthesis function and positioning after transcatheter aortic valve implantation.

Keywords: Aortic stenosis, Doppler, Prosthesis, Surgery, Transcatheter heart valve implantation