- 作者：Rodrigo Bagur ; MD?/sup> ; Josep Rodé ; s-Cabau ; MD?/sup> ; josep.rodes@criucpq.ulaval.ca ; Daniel Doyle ; MD&dagger ; ; Robert De Larochelliè ; re ; MD?/sup> ; Jacques Villeneuve ; MD&Dagger ; ; Jerô ; me Lemieux ; MD&Dagger ; ; Sé ; bastien Bergeron ; MD?/sup> ; Mé ; lanie Cô ; té ; MSc?/sup> ; Olivier F. Bertrand ; MD ; PhD?/sup> ; Philippe Pibarot ; DVM ; PhD?/sup> ; É ; ric Dumont ; MD&dagger ;
- 关键词：aortic stenosis ; transapical ; transcatheter aortic valve implantation ; transesophageal echocardiography
- 刊名：JACC: Cardiovascular Imaging
- 出版年：2011
- 出版时间：February 2011
- 年：2011
- 卷：4
- 期：2
- 页码：115-124
- 全文大小：1141 K
Objectives
The aim of this study was to: 1) determine the usefulness of transesophageal echocardiography (TEE) as the primary technique to guide transapical (TA) transcatheter aortic valve implantation (TAVI); and 2) to compare TEE with angiography as the primary imaging modality for TA-TAVI guidance.Background
TEE has been routinely used as an adjunct to angiography during TA-TAVI procedures, but very few data exist on the use of TEE as the primary imaging technique guiding TA-TAVI.
Methods
One hundred consecutive high-risk patients (mean age 79 ¡À 9 years, mean logistic EuroSCORE: 25.8 ¡À 17.6 % ) who underwent TA-TAVI in our center were included. The Edwards valve was used in all cases, and all procedures were performed in an operating room without hybrid facilities. The TA-TAVI was primarily guided by angiography in the first 25 patients (A-TAVI group) and by TEE in the last 75 patients (TEE-TAVI group). Procedural, 30-day, and follow-up results were evaluated.
Results
No differences were observed between groups at baseline except for a higher (p = 0.001) prevalence of moderate or severe mitral regurgitation in the TEE-TAVI group. The procedure was successful in 97.3 % and 100 % of the patients in the TEE-TAVI and A-TAVI groups, respectively (p = 1.0), and a lower contrast volume was used in the TEE-TAVI group (12 [5 to 20] ml vs. 40 [20 to 50] ml, p < 0.0001). There were no differences between groups in the occurrence of valve malposition needing a second valve (TEE-TAVI: 5.3 % ; A-TAVI: 4 % ; p = 1.0) or valve embolization (TEE-TAVI: 1.3 % ; A-TAVI: 4 % ; p = 0.44). The results regarding post-procedural valve hemodynamic status and aortic regurgitation were similar between groups. The survival rates at 30-day and 1-year follow-up were 87 % and 75 % in the TEE-group and 88 % and 84 % in the A-TAVI group, respectively (log-rank = 0.49).
Conclusions
TEE-TAVI was associated with similar acute and midterm results as A-TAVI and significantly reduced contrast media use during the procedures. These results suggest the feasibility and safety of performing TA-TAVI procedures in an operating room without hybrid facilities, but larger studies are needed to confirm these findings.