Transthoracic Echocardiography Guidance for TAVR Under Monitored Anesthesia Care

Sengupta, Partho P.; Wiley, Brandon M.; Basnet, Sandeep; Rajamanickman, Anitha; Kovacic, Jason C.; Fischer, Gregory W.; Kini, Annapoorna; Sharma, Samin K.

doi:10.1016/j.jcmg.2015.01.002

Cited by 31 publications

(16 citation statements)

References 1 publication

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“…This “minimalist” approach has been shown to be associated with minimal morbidity and mortality and equivalent effectiveness , shorter length of hospitalization , and less resource use compared with the conventional approach. TEE is therefore progressively less utilized and whether transthoracic or intracardiac echocardiography can effectively replace it, is to‐date unclear. On the other hand, angiography remained irreplaceable in procedural guidance.…”

Section: Discussionmentioning

confidence: 99%

Angiographic assessment of aortic regurgitation by video‐densitometry in the setting of TAVI: Echocardiographic and clinical correlates

Abdelghani

Tateishi

Miyazaki

et al. 2017

Cathet Cardio Intervent

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Section: Discussionmentioning

confidence: 99%

Angiographic assessment of aortic regurgitation by video‐densitometry in the setting of TAVI: Echocardiographic and clinical correlates

Abdelghani

Tateishi

Miyazaki

et al. 2017

Cathet Cardio Intervent

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“…Sixteen citations (n = 3510 patients) fulfilled the inclusion and exclusion criteria. There were 10 unmatched (n = 2037 patients) [7,14-22] and 6 matched (n = 1473 patients) [4,[23][24][25][26][27] retrospective observational studies [ Supplementary Figure 1].…”

Section: Resultsmentioning

confidence: 99%

“…The volume of transcatheter aortic valve implantation (TAVI) has surpassed surgical aortic valve replacement in Europe and North America [1][2][3] . Traditionally, TAVI uses general anesthesia (GA) accompanied by intraprocedural transesophageal echocardiography (TEE) to assess root geometry and guide valve placement during the procedure [4] . While rare, TEE can also lead to serious complications such as esophageal perforation, aspiration and oropharyngeal damage [5] .…”

Section: Introductionmentioning

confidence: 99%

Transthoracic vs. transesophageal echocardiography in transcatheter aortic valve implantation: a systematic review and meta-analysis

Lam¹,

Tam²,

Dixit³

et al. 2019

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Aim: Traditionally, transcatheter aortic valve implantation (TAVI) was performed under general anesthesia (GA) accompanied by intraprocedural transesophageal echocardiography (TEE). Recently, minimalist TAVI with monitored anesthesia care (MAC) and transthoracic echocardiography (TTE) has gained popularity. However, TTE imaging quality may be suboptimal compared to TEE and may increase the risks of paravalvular leak (PVL). We sought to compare TTE to TEE for PVL (primary outcome) and secondary safety outcomes in a study-level meta-analysis.Methods: Ovid versions of Medline and Embase were searched from 1946 to 2018 for studies comparing TTE to TEE in TAVI directly or MAC to GA in TAVI (must also specify echocardiography usage) and meta-analyzed in a random effects model. Results:Sixteen studies (n = 3,510) were included in the meta-analysis. The rate of any PVL was not significantly different between TTE-TAVI and TEE-TAVI groups (18.4% vs. 21.4%, risk ratio: 1.01, 95%CI: 0.83 to 1.23, P = 0.92, I 2 = 36%). Similarly, there were no significant differences in secondary safety outcomes. Resource utilization was lower with TTE-TAVI; hospital LOS [mean difference (MD): -1.55 days, 95%CI: -2.27 to -0.83, P < 0.01], contrast volume (MD: -24.75 mL, 95%CI: -49.48 to -0.03, P = 0.05) and procedure time (MD: -31.09 min, 95%CI: -54.77 to -7.40, P < 0.01) were significantly lower. Conclusion:The use of TTE-TAVI in conjunction with MAC was not associated with an increased risk of PVL and was associated with lower hospital resource utilization. However, other factors, such as mode of anesthesia, may have influenced these findings.

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“…Because TAVR procedures are increasingly being performed with conscious sedation, TTE 29 is being increasingly used in lieu of TEE. Both modalities are rated Appropriate.…”

Section: Section 3: Transcatheter Intervention For Vhdmentioning

confidence: 99%

ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease

Doherty

Kort

Mehran

et al. 2017

Journal of Nuclear Cardiology

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Transthoracic Echocardiography Guidance for TAVR Under Monitored Anesthesia Care

Cited by 31 publications

References 1 publication

Angiographic assessment of aortic regurgitation by video‐densitometry in the setting of TAVI: Echocardiographic and clinical correlates

Angiographic assessment of aortic regurgitation by video‐densitometry in the setting of TAVI: Echocardiographic and clinical correlates

Transthoracic vs. transesophageal echocardiography in transcatheter aortic valve implantation: a systematic review and meta-analysis

ACC/AATS/AHA/ASE/ASNC/HRS/SCAI/SCCT/SCMR/STS 2017 Appropriate Use Criteria for Multimodality Imaging in Valvular Heart Disease

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