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Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve Function.

Publication ,  Journal Article
Hahn, RT; Leipsic, J; Douglas, PS; Jaber, WA; Weissman, NJ; Pibarot, P; Blanke, P; Oh, JK
Published in: JACC Cardiovasc Imaging
January 2019

OBJECTIVES: This study aims to establish parameters for identifying normal function for each of the 3 iterations of balloon-expandable valves and 2 iterations of self-expanding valves. BACKGROUND: Expected transthoracic echocardiographic Doppler-derived hemodynamic data for transcatheter aortic valves inform pre-implant decision-making and post-implanted monitoring of longitudinal valve function. METHODS: We collected the echocardiography core Lab measured mean gradients and effective orifice area (EOA) from discharge or 30-day echocardiograms from randomized trials; the PARTNER (Placement of Aortic Transcatheter Valves) trials for the balloon-expandable valves and the Medtronic CoreValve US Pivotal trial and Medtronic CoreValve Evolut R United States IDE Clinical Study for the self-expanding valves. RESULTS: For all SAPIEN (Edwards Lifesciences, Irvine, California) valve sizes, mean EOA is 1.70 ± 0.49 cm2 with a mean gradient of 9.36 ± 4.13 mm Hg. For all SAPIEN XT valve sizes, mean EOA is 1.67 ± 0.46 cm2 with a mean gradient of 9.52 ± 3.64 mm Hg. For all SAPIEN 3 valve sizes, the mean EOA is 1.66 ± 0.38 cm2 with a mean gradient of 11.18 ± 4.35 mm Hg. For all CoreValve valve sizes, the mean EOA is 1.88 ± 0.56 cm2 with a mean gradient of 8.85 ± 4.14 mm Hg. For all Evolut R valve sizes, the mean EOA is 2.01 ± 0.65 cm2 with a mean gradient of 7.52 ± 3.19 mm Hg. The SAPIEN 3 post-implant EOA was progressively larger for each quintile of baseline annular area by computed tomography (p < 0.001). Similarly, for the Evolut R valve, post-implantation EOA was significantly larger for each quintile of baseline annular perimeter (p < 0.001). CONCLUSIONS: Tables of expected mean transcatheter aortic valve hemodynamics by valve type and size are essential in evaluating the function of these transcatheter prosthetic valves. Tables of expected EOA by the native annular anatomy may be useful for pre-implantation decision making. Criteria for defining structural valve dysfunction are proposed.

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Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

January 2019

Volume

12

Issue

1

Start / End Page

25 / 34

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Registries
  • Recovery of Function
  • Randomized Controlled Trials as Topic
  • Prosthesis Design
  • Predictive Value of Tests
  • Multidetector Computed Tomography
  • Humans
 

Citation

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Hahn, R. T., Leipsic, J., Douglas, P. S., Jaber, W. A., Weissman, N. J., Pibarot, P., … Oh, J. K. (2019). Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve Function. JACC Cardiovasc Imaging, 12(1), 25–34. https://doi.org/10.1016/j.jcmg.2018.04.010
Hahn, Rebecca T., Jonathon Leipsic, Pamela S. Douglas, Wael A. Jaber, Neil J. Weissman, Philippe Pibarot, Philipp Blanke, and Jae K. Oh. “Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve Function.JACC Cardiovasc Imaging 12, no. 1 (January 2019): 25–34. https://doi.org/10.1016/j.jcmg.2018.04.010.
Hahn RT, Leipsic J, Douglas PS, Jaber WA, Weissman NJ, Pibarot P, et al. Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve Function. JACC Cardiovasc Imaging. 2019 Jan;12(1):25–34.
Hahn, Rebecca T., et al. “Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve Function.JACC Cardiovasc Imaging, vol. 12, no. 1, Jan. 2019, pp. 25–34. Pubmed, doi:10.1016/j.jcmg.2018.04.010.
Hahn RT, Leipsic J, Douglas PS, Jaber WA, Weissman NJ, Pibarot P, Blanke P, Oh JK. Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve Function. JACC Cardiovasc Imaging. 2019 Jan;12(1):25–34.
Journal cover image

Published In

JACC Cardiovasc Imaging

DOI

EISSN

1876-7591

Publication Date

January 2019

Volume

12

Issue

1

Start / End Page

25 / 34

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Transcatheter Aortic Valve Replacement
  • Time Factors
  • Registries
  • Recovery of Function
  • Randomized Controlled Trials as Topic
  • Prosthesis Design
  • Predictive Value of Tests
  • Multidetector Computed Tomography
  • Humans