Author + information
- Received April 26, 2011
- Accepted June 8, 2011
- Published online October 1, 2011.
- Marie-Annick Clavel, DVM, MSc,
- Josep Rodés-Cabau, MD,
- Éric Dumont, MD,
- Rodrigo Bagur, MD,
- Sébastien Bergeron, MD,
- Robert De Larochellière, MD,
- Daniel Doyle, MD,
- Éric Larose, MD, MSc,
- Jean G. Dumesnil, MD and
- Philippe Pibarot, DVM, PhD⁎ ()
- ↵⁎Reprint request and correspondence:
Dr. Philippe Pibarot, Institut Universitaire de Cardiologie et de Pneumologie de Québec, 2725 Chemin Sainte-Foy, Québec, Québec G1V-4G5, Canada
Objectives The objectives were to compare different Doppler echocardiographic methods for the measurement of prosthetic valve effective orifice area (EOA) following transcatheter aortic valve implantation (TAVI) and to determine the factors influencing the EOA of transcatheter balloon expandable valves.
Background Previous studies have used different methods for the measurement of the valve EOA following TAVI. Factors influencing the EOA of transcatheter valves are unknown.
Methods A total of 122 patients underwent TAVI with the use of the Edwards-SAPIEN valve (Edwards Lifesciences, Irvine, California). The EOA was measured by transthoracic echocardiography at hospital discharge, 6 months and 1 year after TAVI with the use of 2 methods as described in previous studies. In Method #1 (EOA1), LVOT diameter (LVOTd) entered in the continuity equation was measured at the base of prosthesis cusps whereas, in Method #2 (EOA2), LVOTd was measured immediately proximal to the prosthesis stent.
Results The average EOA2 (1.57 ± 0.41 cm2) was larger (p < 0.01) than the EOA1 (1.21 ± 0.38 cm2). Accordingly, incidence of severe PPM (indexed EOA ≤0.65 cm2/m2) was 3-fold lower with the use of EOA2 than with EOA1 (9% vs. 33%; p < 0.001). Mean transprosthetic gradient correlated better (p = 0.03) with indexed EOA2 (r = −0.70, p < 0.0001) than with indexed EOA1 (r = −0.58, p < 0.0001). Intraobserver and interobserver variability were lower for EOA2 compared to EOA1 (intra: 5% vs. 7%, p = 0.06; inter: 6% vs. 14%; p < 0.001). Aortic annulus size was the sole independent determinant (p = 0.01) of prosthetic valve EOA2. The average EOA varied from 1.37 ± 0.23 cm2 for aortic annulus size <19 mm up to 1.90 ± 0.17 cm2 for size >23 mm.
Conclusions When estimating the EOA of Edwards-SAPIEN valves by Doppler-echocardiography, it is recommended to use the LVOT diameter and velocity measured immediately proximal to the stent. The main determinant of the EOA of transcatheter valves is the patient's annulus size and these valves provide excellent hemodynamics even in patients with a small aortic annulus.
Dr. Clavel holds a Vanier Canada Graduate Scholarship, Canadian Institutes of Health Research, Ottawa, Ontario, Canada. Drs. Rodés-Cabau, Dumont, and Doyle hold consultancies and/or are on the speaker's bureau of Edwards Lifesciences and/or they have received research grants from this company. Dr. Rodés-Cabau is a consultant for St. Jude Medical. Dr. Pibarot holds the Canada Research Chair in Valvular Heart Disease, Canadian Institutes of Health Research, Ottawa, Ontario, Canada. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2011.
- Accepted June 8, 2011.
- American College of Cardiology Foundation