Inter-Technique Consistency and Prognostic Value of Intra-Procedural Angiographic and Echocardiographic Assessment of Aortic Regurgitation After Transcatheter Aortic Valve Implantation

Tateishi, Hiroki; Miyazaki, Yosuke; Okamura, Takayuki; Abdelghani, Mohammad; Modolo, Rodrigo; Wada, Yasuaki; Okuda, Shinichi; Omuro, Ayumi; Ariyoshi, Toru; Fujii, Aya; Oda, Tatsuya; Fujimura, Tatsuhiro; Nanno, Takuma; Mikamo, Akihito; Soliman, Osama Ibrahim Ibrahim; Onuma, Yoshinobu; Hamano, Kimikazu; Yano, Masafumi; Serruys, Patrick W.

doi:10.1253/circj.cj-17-1376

Cited by 12 publications

(18 citation statements)

References 22 publications

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“…A quantitative angiographic videodensitometric assessment of paravalvular AR was performed using the CAAS A-Valve 2.0.2 (Pie Medical Imaging BV, Maastricht, The Netherlands). Details of the Core Laboratory methodology are described elsewhere [9][10][11][12][13][14][15][16][17][18]. Aortographic data were analyzed in an independent Core Laboratory (CORRIB Research Center for Advanced Imaging and Core Lab, Galway, Ireland) by experienced analysts who were blinded to the investigators and to other clinical data.…”

Section: Methodsmentioning

confidence: 99%

“…Both the absolute value of AR fraction (between 0 and 100%) as well as grade of severity (none or trace; mild; moderate or severe) were used to compare THV performance between the ACURATE neo2 and the ACURATE neo THVs. The stratification of continuous variable regurgitation fractioninto categorical variables was performed according to the following predetermined threshold criteria: (1) none or trace regurgitation (qAR < 6%); (2) mild (6% ≤ qAR ≤ 17%); and (3) moderate or severe (qAR > 17%) [9][10][11][12][13][14][15][16][17][18]. No other outcome variables were assessed in this study.…”

Section: Methodsmentioning

confidence: 99%

“…Quantitative videodensitometric angiographic assessment of aortic regurgitation (qAR) relies on time-density curves recorded in the region of reference (aortic root) and in the region of interest (left ventricular outflow tract (LVOT)) [3][4][5]. The qAR has been extensively vetted and validated in vitro [6,7], in animal models [8], and in a clinical setting in comparison to transthoracic and transoesophageal echocardiography [9,10], as well as cardiac magnetic resonance imaging [11]. Furthermore, the long-term vital prognostic value of a threshold of 17% in AR has been reported [12].…”

Section: Introductionmentioning

confidence: 99%

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Paravalvular Aortic Regurgitation Severity Assessed by Quantitative Aortography: ACURATE neo2 versus ACURATE neo Transcatheter Aortic Valve Implantation

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Kim

Kawashima

et al. 2021

JCM

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The new-generation ACURATE neo2 system was commercially released in September 2020. In this study, we sought to compare the aortic regurgitation (AR) severity of the ACURATE neo2 versus the ACURATE neo transcatheter heart valve, using quantitative videodensitometric angiography (qAR). This is a retrospective, Corelab analysis of final post-transcatheter aortic valve implantation (TAVI) aortograms of patients treated with the ACURATE neo2 and ACURATE neo systems. The ACURATE neo2 cohort comprised consecutive patients treated between September 2020 and January 2021 at two centers. The ACURATE neo cohort included consecutive patients treated before September 2020. Our primary objective was to compare AR severity on qAR following TAVI with ACURATE neo2 and ACURATE neo. Out of 401 aortograms, 228 (56.9%) were analyzable, with 120 in the ACURATE neo2 cohort, and 108 in the ACURATE neo cohort. The mean AR fraction was 4.4 ± 4.8% in the neo2 cohort, and 9.9 ± 8.2% in the neo cohort (p < 0.001). Furthermore, moderate or severe AR (qAR > 17%) was detected in 2 aortograms (1.7%) in the neo2 cohort and 15 aortograms (13.9%) in the neo cohort (p < 0.001). Quantitative aortography shows a lower rate of moderate or severe paravalvular AR in what is the first European experience of the new-generation, self-expanding ACURATE neo2 when compared to the first-generation ACURATE neo. Moreover, aortographic data need to be correlated and compared to Core Laboratory-adjudicated 30-day echocardiographic data.

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Section: Methodsmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Paravalvular Aortic Regurgitation Severity Assessed by Quantitative Aortography: ACURATE neo2 versus ACURATE neo Transcatheter Aortic Valve Implantation

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Kim

Kawashima

et al. 2021

JCM

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“…There was no direct comparison between quantitative videodensitometric assessment of AR and echocardiographic evaluation in our analysis. However, previous studies have demonstrated that VD-AR >17% corresponded to moderate or severe AR in comparison with trans-thoracic or trans-esophageal echocardiogram, and was associated with an increase in mortality after TAVR (13,17). Moreover, in the VARC-3 criteria recently published (19), AR by videodensitometry is acknowledged as a valid quantitative assessment, although doppler echocardiography remains by tradition and convention the primary modality for assessing and comparing regurgitation after TAVR.…”

Section: Discussionmentioning

confidence: 99%

“…Moderate or severe aortic regurgitation (AR) post transcatheter aortic valve replacement (TAVR) is associated with increased long-term mortality (1,2), therefore accurate procedural assessment of AR is critical for long term results of TAVR. Quantitative videodensitometric assessment of paravalvular leak (PVL) has been extensively vetted and validated in-vitro (3,4), in-vivo (5), and in the clinical setting, such as after TAVR (6)(7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18), and quantitative videodensitometric aortography is an objective, accurate, and reproducible tool for assessment of AR following TAVR that has been advocated, among other techniques, in the VARC three consensus as a reliable modality of AR assessment (19).…”

Section: Introductionmentioning

confidence: 99%

Comparative Quantitative Aortographic Assessment of Regurgitation in Patients Treated With VitaFlow Transcatheter Heart Valve vs. Other Self-Expanding Systems

Wang

Kawashima

Gao

et al. 2022

Front. Cardiovasc. Med.

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ObjectivesTo compare the quantitative angiographic aortic regurgitation (AR) of six self-expanding valves after transcatheter aortic valve replacement (TAVR).BackgroundQuantitative videodensitometric aortography (LVOT-AR) is an accurate and reproducible tool for assessment of AR following TAVR.MethodsThis is a retrospective central core-lab analysis of 1,257 consecutive cine aortograms performed post-TAVR. The study included 107 final aortograms of consecutive patients who underwent TAVR with first-generation VitaFlow in four Chinese centers and 1,150 aortograms with five other transcatheter aortic valves (Evolut Pro, Evolut R, CoreValve, Venus A-Valve, and Acurate Neo). LVOT-AR analyses of these five valves were retrieved from a previously published pooled database.ResultsAmong 172 aortograms of patients treated with VitaFlow, 107 final aortograms (62.2%) were analyzable by LVOT-AR. In this first in man eight cases necessitated a procedural valve in valve due to inappropriate TAVR positioning and severe aortic paravalvular regurgitation. In the VitaFlow group, the mean LVOT-AR of the intermediate aortograms was 7.3 ± 7.8% and the incidence of LVOT-AR >17% was 8.6%. The mean LVOT-AR of the final aortogram was 6.1 ± 6.4% in the VitaFlow group, followed by Evolut Pro (7.3 ± 6.5%), Evolut R (7.9 ± 7.4%), Venus A-valve (8.9 ± 10.0%), Acurate Neo (9.6 ± 9.2%), and lastly CoreValve (13.7 ± 10.7%) (analysis of variance p < 0.001). Post hoc 2-by-2 testing showed that CoreValve had significantly higher LVOT-AR compared with each of the other five THVs. No statistical difference in LVOT-AR was observed between VitaFlow, Evolut Pro, Evolut R, Acurate Neo, and Venus A-valves. The VitaFlow system had the lowest proportion of patients with LVOT-AR >17% (4.7%) (AR after the final aortograms), followed by Evolut Pro (5.3%), Evolut R (8.8%), Acurate Neo (11.3%), Venus A-valve (14.2%), and CoreValve (30.1%) (chi-square p < 0.001).ConclusionCompared to other commercially available self-expanding valves, VitaFlow seems to have a low degree of AR and a low proportion of patients with ≥moderate/severe AR as assessed by quantitative videodensitometric angiography. Once the learning phase is completed, comparisons of AR between different transcatheter heart valves should be attempted in a prospective randomized trial.

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Association between three-year mortality after transcatheter aortic valve implantation and paravalvular regurgitation graded by videodensitometry in comparison with visual grading

et al. 2023

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Background Estimation of regurgitant fraction by videodensitometry (VD-AR) of aortic root angiograms is a new tool for objective grading of paravalvular regurgitation (PVR) after transcatheter aortic valve implantation (TAVI). Stratification with boundaries at 6% and 17% has been proposed to reflect “none/trace”, “mild” and “moderate or higher” PVR. Objective We sought to investigate the association of strata of VD-AR with 3-year mortality and to compare VD-AR with visual grading of angiograms. Methods We interrogated our database for patients undergoing transfemoral TAVI from 2008 to 2018. Vital status of the patients was obtained from population registers. To test differences in survival and estimate adjusted hazard ratios (HRs) we fitted Cox models. Results Our retrospective study included 699 patients with evaluable angiograms at completion of the TAVI procedure. Cumulative 3-year mortality was 35.0% in 261 (37.3%) patients with VD-AR < 6%, 33.9% in 325 (46.5%) patients with VD-AR between 6 and 17% (HR [95% confidence interval] 1.06 [0.80–1.42]; P = 0.684) and 47.2% in 113 (16.2%) patients with VD-AR > 17% (HR 1.57 [1.11–2.22]; P = 0.011). Visually, PVR was graded as “none/trace” in 470 (67.2%) patients, as “mild” in 219 (31.3%) and as “moderate” in 10 (1.4%). Both mild PVR and moderate PVR on visual grading were significantly associated with mortality (HRs 1.31 [1.12–1.54]; P = 0.001 and 1.92 [1.13–3.24]; P = 0.015; respectively). Conclusions VD-AR > 17%, but not VD-AR 6–17%, was independently associated with mortality. Compared with subjective visual evaluation, VD-AR resulted in a smaller proportion of patients with PVR classified as prognostically relevant. Graphical Abstract

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Inter-Technique Consistency and Prognostic Value of Intra-Procedural Angiographic and Echocardiographic Assessment of Aortic Regurgitation After Transcatheter Aortic Valve Implantation

Abstract: VD (LVOT-AR) has good intra-procedural inter-technique consistency and clinical robustness. Greater than mild post-TAVI AR, but not mild post-TAVI AR, is associated with late mortality.

Cited by 12 publications

References 22 publications

Paravalvular Aortic Regurgitation Severity Assessed by Quantitative Aortography: ACURATE neo2 versus ACURATE neo Transcatheter Aortic Valve Implantation

Paravalvular Aortic Regurgitation Severity Assessed by Quantitative Aortography: ACURATE neo2 versus ACURATE neo Transcatheter Aortic Valve Implantation

Comparative Quantitative Aortographic Assessment of Regurgitation in Patients Treated With VitaFlow Transcatheter Heart Valve vs. Other Self-Expanding Systems

Association between three-year mortality after transcatheter aortic valve implantation and paravalvular regurgitation graded by videodensitometry in comparison with visual grading

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