NATIONAL HARBOR, MD. – Transesophageal echocardiography during percutaneous valve replacement plays an important role in monitoring patients and has the potential to prevent intraprocedural complications, according to a single-center retrospective study.
"There has not been a study that has looked at intraprocedural complications," said Dr. Aditya Saini, lead author and assistant researcher at Clinical Echocardiography Laboratory at MedStar Washington Hospital Center, in the District of Columbia. "We wanted to find out what exactly were the rates and incidence of these complications," Dr. Saini said at the annual meeting of the American Society of Echocardiography.
Dr. Saini Aditya
Several studies from Europe and Canada have already established the importance of TEE during transcatheter aortic valve implantation (TAVI) (JACC Cardiovasc. Imaging 2008;1:15-24).
Dr. Saini and colleagues reviewed intraprocedural 3D-TEE images of 216 consecutive TAVI (commonly referred to as transcatheter aortic valve replacement or TAVR) procedures at MedStar Washington Hospital Center between May 2007 and November 2011. Edwards SAPIEN prosthetic valve was used in the procedure, and implanted through the transapical (27.3% of the patients) or transfemoral (72.7%) approach. All valves were seated appropriately.
Researchers also recorded the occurrence of mobile thrombi immediately after the valves’ implantation.
Results showed that perivalvular leak was the most common observation during the procedure and occurred in roughly 80% of the cases, usually mild and of moderate severity in only 8.7% of the cases. Other complications, which occurred in one or two patients each, included severe central aortic incompetence, ruptured chord off anterior mitral leaflet, new wall motion abnormalities, ascending aortic dissection, and new pericardial effusion.
The most common location for mobile thrombi was the aortic arch (15% of the cases). The thrombi were also observed in the left atrium, left atrial appendage, attached to the catheter in LVOT, attached to native aortic valve after valve implantation, between the prosthesis and aortic annulus, in one or two patients each.
The study’s findings are "nothing earth shattering or new," said Dr. Steven A. Goldstein of MedStar Washington Hospital Center. Dr. Goldstein oversaw the study. "It’s a nice study because it’s a collection of data."
The study "lays down a baseline with a substantial number of patients," said Dr. Saini, chief resident in internal medicine at MedStar Harbor Hospital in Baltimore. "We can’t draw any conclusions from an observational study, but it always starts from the basics."
TEE is routinely used during TAVI to help with balloon positioning, assessing paravalvular aortic regurgitation, and detecting the device’s function and immediate complications, according to the authors.
Dr. Saini and Dr. Goldstein had no relevant disclosures.