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Intra-procedural monitoring protocol using routine transthoracic echocardiography with backup trans-oesophageal probe in transcatheter aortic valve replacement: a single centre experience
- Source :
- European heart journal. Cardiovascular Imaging. 21(1)
- Publication Year :
- 2018
-
Abstract
- Aim The aim of this study is to describe our 9-year experience in transcatheter aortic valve replacement (TAVR) using transthoracic echocardiography (TTE) as a routine intra-procedural imaging modality with trans-oesophageal echocardiography (TEE) as a backup. Methods and results From January 2008 to December 2017, 1218 patients underwent transfemoral TAVR at our Institution. Except the first 20 cases, all procedures have been performed under conscious sedation, with fluoroscopic guidance and TTE imaging monitoring. Once the TTE resulted suboptimal for final result assessment or a complication was either suspected or identified on TTE, TEE evaluation was promptly performed under general anaesthesia. Only 24 (1.9%) cases required a switch to TEE: 6 cases for suboptimal TTE prosthetic valve leak (PVL) quantification; 12 cases for haemodynamic instability; 2 cases for pericardial effusion without haemodynamic instability; 4 cases for urgent TAVR. The 30-days and 1-year all-cause mortality were 2.1% and 10.2%, respectively. Cardiac mortality at 30-days and 1-year follow-up were 0.6% and 4.1%, respectively. Intra-procedural and pre-discharge TT evaluation showed good agreement for PVL quantification (k agreement: 0.827, P = 0.005). Conclusion TTE monitoring seems a reasonable imaging tool for TAVR intra-procedural monitoring without delay in diagnosis of complications and a reliable paravalvular leak assessment. However, TEE is undoubtedly essential in identifying the exact mechanism in most of the complications.
- Subjects :
- medicine.medical_specialty
Leak
Cardiac Catheterization
Sedation
medicine.medical_treatment
030204 cardiovascular system & hematology
Pericardial effusion
Transcatheter Aortic Valve Replacement
03 medical and health sciences
0302 clinical medicine
Valve replacement
medicine
Medical imaging
Fluoroscopy
echocardiography
Humans
Radiology, Nuclear Medicine and imaging
General anaesthesia
030212 general & internal medicine
transcatheter aortic valve implantation
Heart Valve Prosthesis Implantation
medicine.diagnostic_test
business.industry
General Medicine
Aortic Valve Stenosis
medicine.disease
fluoroscopy
Treatment Outcome
intra-procedural monitoring
Echocardiography
Aortic Valve
Heart Valve Prosthesis
Radiology
medicine.symptom
Cardiology and Cardiovascular Medicine
Complication
business
Echocardiography, Transesophageal
Subjects
Details
- ISSN :
- 20472412
- Volume :
- 21
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- European heart journal. Cardiovascular Imaging
- Accession number :
- edsair.doi.dedup.....c8237ca9e5b53824211bb0da92638d44