Comparison of the 3-class and 5-class grading schemes for quantification of paravalvular regurgitation during transcatheter aortic valve implantation

    Authors

    Keywords

    cardiovascular imaging, transesophageal echocardiography, transcatheter aortic valve implantation, paravalvular regurgitation

    DOI

    https://doi.org/10.15836/ccar2019.230

    Full Text

    Introduction : More than mild paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) represents one of the negative predictive factor for survival and quality of life after TAVI ( 1 ). However, quantification and definition of more than mild PVR remains to be unified. Most commonly used 3 stage grading scheme is often insufficient ( 2 ). Aim of this research was to assess differences in incidence of more than mild PVR during and after TAVI comparing 3 and 5 grades staging schemes. Patients and Methods : Study included 40 patients that underwent TAVI between July 2016 and January 2019 in general anesthesia with transesophageal echocardiography (TEE) during procedure. TEE exams had to be sufficiently recorded to quantify PVR with both grading schemes. Parameters used for PVR quantification and differences between models are presented in Table 1 . Results : After initial valve implantation 10 (25%) patients had more than mild PVR when quantified using 3 grade model compared to 19 (47.5%) using 5 grade model (p<0.001). Furthermore, 2 patients with severe PVR assessed by 5 stage model were stratified as having moderate PVR using 3 stage model. In total 14 (35%) patients underwent postdilatation and in 3 (7.5%) of them additional valve was implanted. As final result more than mild PVR was present in 2 (5%) patients using 3 grade model and in 12 (30%) using 5 grade model (p=0.027). Detailed stratification of PVR severity is presented in Table 2 . Conclusion : Utilization of proposed 5 stage grading scheme for evaluation of PRV after TAVI provides more detailed stratification of PVR compared to 3 stage model. The largest difference between models is observed in patients with borderline, mild to moderate PVR. Whether this have implications on patient clinical outcome remains to be determined.

    Cardiologia Croatica
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    Comparison of the 3-class and 5-class grading schemes for quantification of paravalvular regurgitation during transcatheter aortic valve implantation

    Extended Abstract
    Issue9-10
    Published
    Pages230-231
    PDF via DOIhttps://doi.org/10.15836/ccar2019.230
    cardiovascular imaging
    transesophageal echocardiography
    transcatheter aortic valve implantation
    paravalvular regurgitation

    Authors

    Zvonimir Ostojić*ORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Vlatka Rešković LukšićORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Blanka Glavaš KonjaORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Marija ManceORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Ivica ŠafradinORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Joško BulumORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia
    Jadranka Šeparović HanževačkiORCIDUniversity Hospital Centre Zagreb, Zagreb, Croatia

    Full Text

    Introduction : More than mild paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI) represents one of the negative predictive factor for survival and quality of life after TAVI ( 1 ). However, quantification and definition of more than mild PVR remains to be unified. Most commonly used 3 stage grading scheme is often insufficient ( 2 ). Aim of this research was to assess differences in incidence of more than mild PVR during and after TAVI comparing 3 and 5 grades staging schemes. Patients and Methods : Study included 40 patients that underwent TAVI between July 2016 and January 2019 in general anesthesia with transesophageal echocardiography (TEE) during procedure. TEE exams had to be sufficiently recorded to quantify PVR with both grading schemes. Parameters used for PVR quantification and differences between models are presented in Table 1 . Results : After initial valve implantation 10 (25%) patients had more than mild PVR when quantified using 3 grade model compared to 19 (47.5%) using 5 grade model (p<0.001). Furthermore, 2 patients with severe PVR assessed by 5 stage model were stratified as having moderate PVR using 3 stage model. In total 14 (35%) patients underwent postdilatation and in 3 (7.5%) of them additional valve was implanted. As final result more than mild PVR was present in 2 (5%) patients using 3 grade model and in 12 (30%) using 5 grade model (p=0.027). Detailed stratification of PVR severity is presented in Table 2 . Conclusion : Utilization of proposed 5 stage grading scheme for evaluation of PRV after TAVI provides more detailed stratification of PVR compared to 3 stage model. The largest difference between models is observed in patients with borderline, mild to moderate PVR. Whether this have implications on patient clinical outcome remains to be determined.