Background: Transesophageal echocardiography (TEE) in not universally implemented in the screening process of patients with aortic stenosis (AS) referred for trans-catheter aortic valve implantation (TAVI). Therefore, we looked at our institutional data on the impact of TEE on patients’ allocation for TAVI, and its results.
Methods: Our institutional database was sought for patients with native valve AS undergoing TEE screening for TAVI. Real-time 3-dimentional TEE was used whenever available. Sizing was reconfirmed by a dedicated TAVI team. We looked at valve sizing as determined by pre- procedural TEE and its relation to post-procedural outcome.
Results: During a 70 months period (11/2008-08/2014), 294 following patients underwent TAVI due to severe AS in native valve; 260/294 (88%) patients (age 82±4.12, 148 female, 56%) underwent TEE for determination of valve choice, as part of TAVI screening. The transplanted models were Corevalve in 181 patients (23, 26, 29, 31 mm), and Edwards Sapien in 79 patients (23, 26, 29 mm). In 19/260 patients there was a mismatch between TEE-based recommendations and implanted valve size (5larger and 14smaller). Perivalvular leak, estimated by echocardiography at the end of the procedure (255 patients) was≤ mild, mild to moderate and≥ moderate in 218(85%), 36(14%), 1(0.3%) patients, respectively. The corresponding perivalvular leak grade at one month was 188(78%), 44(18%), 7(2%) out of 239 patients, respectively. The perivalvular leak rate in the group of patients with mismatched valve was 9/19 at the end of the procedure and 6/19 following 1 month. Post-dilatation was required in 36 patients (4/79-5%) in Edwards Sapien valves, and 32/181 (18%) in patients with Corevalve. There was one case of valve migration and one case of fatal root rupture.
Conclusion: Valve choice for TAVI can be reliably planned by TEE sizing, with a very small rate of significant perivalvular leak or serious valve-related complications .
