Author:
Abdelshafy Mahmoud,Serruys Patrick W.,Tsai Tsung-Ying,Revaiah Pruthvi Chenniganahosahalli,Garg Scot,Aben Jean-Paul,Schultz Carl J.,Abdelghani Mohammad,Tonino Pim A. L.,Miyazaki Yosuke,Rutten Marcel C. M.,Cox Martijn,Sahyoun Cherif,Teng Justin,Tateishi Hiroki,Abdel-Wahab Mohamed,Piazza Nicolo,Pighi Michele,Modolo Rodrigo,van Mourik Martijn,Wykrzykowska Joanna,de Winter Robbert J.,Lemos Pedro A.,de Brito Fábio S.,Kawashima Hideyuki,Søndergaard Lars,Rosseel Liesbeth,Wang Rutao,Gao Chao,Tao Ling,Rück Andreas,Kim Won-Keun,Royen Niels van,Terkelsen Christian J.,Nissen Henrik,Adam Matti,Rudolph Tanja K.,Wienemann Hendrik,Torii Ryo,Josef Neuman Franz,Schoechlin Simon,Chen Mao,Elkoumy Ahmed,Elzomor Hesham,Amat-Santos Ignacio J.,Mylotte Darren,Soliman Osama,Onuma Yoshinobu
Abstract
Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models. In the clinical setting, LVOT-AR was compared with trans-thoracic and trans-oesophageal echocardiography and cardiac magnetic resonance imaging. LVOT-AR > 17% discriminates mild from moderate aortic regurgitation on echocardiography and confers a poor prognosis in multiple registries, and justifies balloon post-dilatation. The LVOT-AR differentiates the individual performances of many old and novel devices and is being used in ongoing randomized trials and registries.
Subject
Cardiology and Cardiovascular Medicine