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Comprehensive Echocardiographic Assessment of Normal Transcatheter Valve Function.

by Weissman, Neil J.
Citation: Jacc: Cardiovascular Imaging. 12(1):25-34, 2019 01..Journal: JACC. Cardiovascular imaging.Published: 2019; ISSN: 1876-7591.Full author list: Blanke P; Douglas PS; Hahn RT; Jaber WA; Leipsic J; Oh JK; Pibarot P; Weissman NJ.UI/PMID: 29909110.Subject(s): *Aortic Valve Stenosis/dg [Diagnostic Imaging] | *Aortic Valve Stenosis/su [Surgery] | *Aortic Valve/dg [Diagnostic Imaging] | *Aortic Valve/su [Surgery] | *Bioprosthesis | *Echocardiography, Doppler | *Heart Valve Prosthesis | *Hemodynamics | *Transcatheter Aortic Valve Replacement/is [Instrumentation] | Aortic Valve Stenosis/pp [Physiopathology] | Aortic Valve/pp [Physiopathology] | Balloon Valvuloplasty | Humans | Multidetector Computed Tomography | Predictive Value of Tests | Prosthesis Design | Randomized Controlled Trials as Topic | Recovery of Function | Registries | Time Factors | Transcatheter Aortic Valve Replacement/ae [Adverse Effects] | Treatment OutcomeInstitution(s): MedStar Heart & Vascular InstituteActivity type: Journal Article.Medline article type(s): Journal ArticleOnline resources: Click here to access online Digital Object Identifier: https://dx.doi.org/10.1016/j.jcmg.2018.04.010 (Click here) Abbreviated citation: JACC Cardiovasc Imaging. 12(1):25-34, 2019 01.Abstract: 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.Abstract: 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.Abstract: Copyright (c) 2018 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.Abstract: 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.Abstract: 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.Abstract: RESULTS: For all SAPIEN (Edwards Lifesciences, Irvine, California) valve sizes, mean EOA = 1.70 +/- 0.49 cm<sup>2</sup> with mean gradient of 9.36 +/- 4.13 mm Hg. For all SAPIEN XT valve sizes, mean EOA = 1.67 +/- 0.46 cm<sup>2</sup> with mean gradient of 9.52 +/- 3.64 mm Hg. For all SAPIEN 3 valve sizes, the mean EOA = 1.66 +/- 0.38 cm<sup>2</sup> with mean gradient of 11.18 +/- 4.35 mm Hg. For all CoreValve valve sizes, the mean EOA = 1.88 +/- 0.56 cm<sup>2</sup> with mean gradient of 8.85 +/- 4.14 mm Hg. For all Evolut R valve sizes, the mean EOA = 2.01 +/- 0.65 cm<sup>2</sup> with 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).

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