Aortic Valve Insufficiency/diagnostic imaging

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Original Article

The Role of Quantitative Aortographic Assessment of Aortic Regurgitation by Videodensitometry in the Guidance of Transcatheter Aortic Valve Implantation

Yosuke Miyazaki et al. Rodrigo Modolo Mohammad Abdelghani Hiroki Tateishi … Rafael Cavalcante Carlos Collet Taku Asano Yuki Katagiri Erhan Tenekecioglu Rogério Sarmento-Leite José A. Mangione Alexandre Abizaid Osama I.I. Soliman Yoshinobu Onuma Patrick W. Serruys Pedro A. Lemos Fabio S. de Brito Jr.

Abstract

Background:

Balloon post-dilatation (BPD) is often needed for optimizing transcatheter heart valve (THV) implantation, since paravalvular leak (PVL) after transcatheter aortic valve implantation is associated with poor outcome and mortality. Quantitative assessment of PVL severity before and after BPD is mandatory to properly assess PVL, thus improving implantation results and outcomes.

Objective:

To investigate a quantitative angiographic assessment of aortic regurgitation (AR) by videodensitometry before and after BPD.

Methods:

Videodensitometric-AR assessments (VD-AR) before and after BPD were analysed in 61 cases.

Results:

VD-AR decreased significantly from 24.0[18.0-30.5]% to 12.0[5.5-19.0]% (p < 0.001, a two-tailed p 17%) was observed in 47 patients (77%) before and in 19 patients (31%) after BPD.

Conclusions:

VD-AR after THV implantation provides a quantitative assessment of post-TAVI regurgitation and can help in the decision-making process on performing BPD and in determining its efficacy.

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Editorial

New Method Improves the Assessment of Aortic Regurgitation Grade during TAVR by Aortography

Henrique B. Ribeiro

Transcatheter aortic valve replacement (TAVR) is a rapidly expanding alternative to surgical aortic valve replacement for patients deemed inoperable or at high or intermediate operative risk. Yet, residual aortic regurgitation (AR) secondary to paravalvular leaks (PVL) remains a procedural limitation. Although residual AR after TAVR is frequent, affecting up to approximately 70% of the treated patients,^– it is moderate to severe in approximately 12% of these and steadily below 5% with current-generation devices, which come with specific sealing features. Noteworthy, moderate/severe AR has a detrimental clinical impact after TAVR, with a 3-fold increase in 30-day mortality and a 2.3-fold increase in 1-year mortality. Thus, its accurate assessment and quantification with a multimodality approach is key for appropriate utilization of additional procedures to reduce PVL, such as balloon post-dilatation (BPD), valve-in-valve, or leak closure.^,

While Doppler echocardiography has been the most common method to assess AR following TAVR, its accurate quantification is challenging since AR jets are often multiple and eccentric.^,^– Therefore, other methods for proper AR assessment have been evaluated in recent years, such as 3D echocardiography, hemodynamic AR index, aortography and even cardiovascular magnetic resonance, each one with its specific advantages and disadvantages.^,^,

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