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Current Cardiology Reports
Published in: Current Cardiology Reports 12/2017

01-12-2017 | Valvular Heart Disease (T Kiefer, Section Editor)

Role of Echocardiography in Transcatheter Valvular Heart Disease Interventions

Authors: Omar K. Khalique, Rebecca T. Hahn

Published in: Current Cardiology Reports | Issue 12/2017

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Abstract

Purpose of Review

Transcatheter valvular interventions have increased in importance and utility for surgical valve repair and replacement. Cardiac imaging is the most crucial aspect of procedural planning and guidance. Echocardiography is a widely used, portable, and dynamic imaging modality used for many of these interventions. This review will summarize the role echocardiography in structural heart valvular interventions.

Recent Findings

Intraprocedural echocardiographic guidance has been a mainstay of structural heart interventions. Over the years, the use of 3-dimensional echocardiography has increased, and studies have shown utility in paravalvular leak prediction in the setting of transcatheter aortic valve replacement, procedural guidance in MitraClip repair, and in mitral and tricuspid valve therapies.

Summary

Intraprocedural echocardiography is of paramount important for procedural success during all structural heart valvular interventions. Continued use of 2 and 3-dimensional echocardiography will be a major factor in driving the innovative field of structural heart interventions forward.
Literature
1.
Hahn RT, Khalique O, Williams MR, Koss E, Paradis JM, Daneault B, et al. Predicting paravalvular regurgitation following transcatheter valve replacement: utility of a novel method for three-dimensional echocardiographic measurements of the aortic annulus. J Am Soc Echocardiogr. 2013;26:1043–52.CrossRefPubMed
2.
Khalique OK, Kodali S, Paradis JM, Nazif TM, Williams MR, Einstein AJ, et al. Aortic annular sizing using a novel 3-dimensional echocardiographic method: utility and comparison to cardiac computed tomography. Circ Cardiovasc Imaging. 2013;
3.
Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, et al. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med. 2010;363:1597–607.CrossRefPubMed
4.
Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364:2187–98.CrossRefPubMed
5.
Holmes DR Jr, Nishimura RA, Grover FL, Brindis RG, Carroll JD, Edwards FH, et al. Annual outcomes with transcatheter valve therapy: from the STS/ACC TVT registry. Ann Thorac Surg. 2016;101:789–800.CrossRefPubMed
6.
de Brito FS Jr, Carvalho LA, Sarmento-Leite R, Mangione JA, Lemos P, Siciliano A, et al., Brazilian TRi. Outcomes and predictors of mortality after transcatheter aortic valve implantation: results of the Brazilian registry. Catheter Cardiovasc Interv. 2015;85:E153–62.
7.
D'Errigo P, Ranucci M, Covello RD, Biancari F, Rosato S, Barbanti M, et al., Group OR. Outcome after general anesthesia versus monitored anesthesia care in transfemoral transcatheter aortic valve replacement. J Cardiothorac Vasc Anesth. 2016;30:1238–43.
8.
Hayek SS, Corrigan FE 3rd, Condado JF, Lin S, Howell S, MacNamara JP, et al. Paravalvular regurgitation after transcatheter aortic valve replacement: comparing transthoracic versus transesophageal echocardiographic guidance. J Am Soc Echocardiogr. 2017;
9.
Van Belle E, Juthier F, Susen S, Vincentelli A, Iung B, Dallongeville J, et al. Postprocedural aortic regurgitation in balloon-expandable and self-expandable transcatheter aortic valve replacement procedures: analysis of predictors and impact on long-term mortality: insights from the FRANCE2 registry. Circulation. 2014;129:1415–27.CrossRefPubMed
10.
Jabbar A, Khurana A, Mohammed A, Das R, Zaman A, Edwards R. Local versus general anesthesia in transcatheter aortic valve replacement. Am J Cardiol. 2016;118:1712–6.CrossRefPubMed
11.
Konigstein M, Ben-Shoshan J, Zahler D, Flint N, Margolis G, Granot Y, et al. Outcome of patients undergoing TAVR with and without the attendance of an anesthesiologist. Int J Cardiol. 2017;
12.
Attizzani GF, Alkhalil A, Padaliya B, Tam CC, Lopes JP, Fares A, et al. Comparison of outcomes of transfemoral transcatheter aortic valve implantation using a minimally invasive versus conventional strategy. Am J Cardiol. 2015;116:1731–6.CrossRefPubMed
13.
Hyman MC, Vemulapalli S, Szeto WY, Stebbins A, Patel PA, Matsouaka RA, et al. Conscious sedation versus general anesthesia for transcatheter aortic valve replacement: insights from the NCDR(R) STS/ACC TVT registry. Circulation. 2017;
14.
Lauck SB, Wood DA, Baumbusch J, Kwon JY, Stub D, Achtem L, et al. Vancouver transcatheter aortic valve replacement clinical pathway: minimalist approach, standardized care, and discharge criteria to reduce length of stay. Circ Cardiovasc Qual Outcomes. 2016;9:312–21.CrossRefPubMed
15.
Hahn RT, Little SH, Monaghan MJ, Kodali SK, Williams M, Leon MB, et al. Recommendations for comprehensive intraprocedural echocardiographic imaging during TAVR. JACC Cardiovasc Imaging. 2015;8:261–87.CrossRefPubMed
16.
Mulier JP, Wouters PF, Van Aken H, Vermaut G, Vandermeersch E. Cardiodynamic effects of propofol in comparison with thiopental: assessment with a transesophageal echocardiographic approach. Anesth Analg. 1991;72:28–35.CrossRefPubMed
17.
Pershad A, Fraij G, Girotra SV, Fang HK, Gellert G. TEE-guided transcatheter aortic valve implantation with “zero contrast” - a viable alternative for patients with chronic kidney disease. J Invasive Cardiol. 2015;27:E25–6.PubMed
18.
Eskandari M, Aldalati O, Byrne J, Dworakowski R, Wendler O, Alcock E, et al. Zero contrast transfemoral transcatheter aortic valve replacement using fluoroscopy-echocardiography fusion imaging. Am J Cardiol. 2016;117:1861–2.CrossRefPubMed
19.
Makkar RR, Fontana G, Jilaihawi H, Chakravarty T, Kofoed KF, de Backer O, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N Engl J Med. 2015;373:2015–24.CrossRefPubMed
20.
Yanagisawa R, Hayashida K, Yamada Y, Tanaka M, Yashima F, Inohara T, et al. Incidence, predictors, and mid-term outcomes of possible leaflet thrombosis after TAVR. JACC Cardiovasc Imaging. 2016;
21.
Thourani VH, Kodali S, Makkar RR, Herrmann HC, Williams M, Babaliaros V, Smalling R, Lim S, Malaisrie SC, Kapadia S, Szeto WY, Greason KL, Kereiakes D, Ailawadi G, Whisenant BK, Devireddy C, Leipsic J, Hahn RT, Pibarot P, Weissman NJ, Jaber WA, Cohen DJ, Suri R, Tuzcu EM, Svensson LG, Webb JG, Moses JW, Mack MJ, Miller DC, Smith CR, Alu MC, Parvataneni R, D'Agostino RB, Jr. and Leon MB. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet 2016;387:2218–2225.
22.
Kappetein AP, Head SJ, Généreux P, Piazza N, van Mieghem NM, Blackstone EH, et al. Consortium-2 VAR. Updated standardized endpoint definitions for transcatheter aortic valve implantation: the Valve Academic Research Consortium-2 consensus document. J Thorac Cardiovasc Surg. 2013;145:6–23.CrossRefPubMed
23.
Pibarot P, Hahn RT, Weissman NJ, Monaghan MJ. Assessment of paravalvular regurgitation following TAVR: a proposal of unifying grading scheme. JACC Cardiovasc Imaging. 2015;8:340–60.CrossRefPubMed
24.
Hahn RT, Pibarot P, Weissman NJ, Rodriguez L, Jaber WA. Assessment of paravalvular aortic regurgitation after transcatheter aortic valve replacement: intra-core laboratory variability. J Am Soc Echocardiogr. 2015;28:415–22.CrossRefPubMed
25.
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Guyton RA, et al. American College of Cardiology/American Heart Association Task Force on Practice G. 2014 AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2014;63:2438–88.CrossRefPubMed
26.
Pighi M, Estevez-Loureiro R, Maisano F, Ussia GP, Dall'Ara G, Franzen O, et al., Transcatheter Valve Treatment Sentinel Registry Investigators of the ERPotESoC. Immediate and 12-month outcomes of ischemic versus nonischemic functional mitral regurgitation in patients treated with MitraClip (from the 2011 to 2012 pilot sentinel registry of percutaneous edge-to-edge mitral valve repair of the European Society of Cardiology). Am J Cardiol. 2017;119:630–7.
27.
Schwencke C, Bijuklic K, Ouarrak T, Lubos E, Schillinger W, Plicht B, et al. Impact of cardiac comorbidities on early and 1-year outcome after percutaneous mitral valve interventions: data from the German transcatheter mitral valve interventions (TRAMI) registry. Clin Res Cardiol. 2017;106:249–58.CrossRefPubMed
28.
Schafer U, Maisano F, Butter C, Franzen O, Baldus S, Hausleiter J, et al. Impact of preprocedural left ventricular ejection fraction on 1-year outcomes after MitraClip implantation from the ACCESS-EU phase I, a prospective, multicenter, nonrandomized postapproval study of the MitraClip therapy in Europe. Am J Cardiol. 2016;118:873–80.CrossRefPubMed
29.
Feldman T, Kar S, Rinaldi M, Fail P, Hermiller J, Smalling R, et al. Percutaneous mitral repair with the MitraClip system: safety and midterm durability in the initial EVEREST (Endovascular Valve Edge-to-Edge REpair Study) cohort. J Am Coll Cardiol. 2009;54:686–94.CrossRefPubMed
30.
Attizzani GF, Ohno Y, Capodanno D, Cannata S, Dipasqua F, Imme S, et al. Extended use of percutaneous edge-to-edge mitral valve repair beyond EVEREST (Endovascular Valve Edge-to-Edge Repair) criteria: 30-day and 12-month clinical and echocardiographic outcomes from the GRASP (Getting Reduction of Mitral Insufficiency by Percutaneous Clip Implantation) registry. JACC Cardiovasc Interv. 2015;8:74–82.CrossRefPubMed
31.
Bottari VE, Tamborini G, Bartorelli AL, Alamanni F, Pepi M. MitraClip implantation in a previous surgical mitral valve edge-to-edge repair. JACC Cardiovasc Interv. 2015;8:111–3.CrossRefPubMed
32.
Estevez-Loureiro R, Franzen O, Winter R, Sondergaard L, Jacobsen P, Cheung G, et al. Echocardiographic and clinical outcomes of central versus noncentral percutaneous edge-to-edge repair of degenerative mitral regurgitation. J Am Coll Cardiol. 2013;62:2370–7.CrossRefPubMed
33.
Lubos E, Schluter M, Vettorazzi E, Goldmann B, Lubs D, Schirmer J, et al. MitraClip therapy in surgical high-risk patients: identification of echocardiographic variables affecting acute procedural outcome. JACC Cardiovasc Interv. 2014;7:394–402.CrossRefPubMed
34.
•• Hahn RT. Transcathether valve replacement and valve repair: review of procedures and intraprocedural echocardiographic imaging. Circ Res. 2016;119:341–56. This is an excellent overall review of structural heart procedures CrossRefPubMed
35.
Altiok E, Hamada S, Brehmer K, Kuhr K, Reith S, Becker M, et al. Analysis of procedural effects of percutaneous edge-to-edge mitral valve repair by 2D and 3D echocardiography. Circ Cardiovasc Imaging. 2012;5:748–55.CrossRefPubMed
36.
Tamburino C, Ussia GP, Maisano F, Capodanno D, La Canna G, Scandura S, et al. Percutaneous mitral valve repair with the MitraClip system: acute results from a real world setting. Eur Heart J. 2010;31:1382–9.CrossRefPubMedPubMedCentral
37.
Herrmann HC, Kar S, Siegel R, Fail P, Loghin C, Lim S, et al. Effect of percutaneous mitral repair with the MitraClip device on mitral valve area and gradient. EuroIntervention. 2009;4:437–42.CrossRefPubMed
38.
Stone GW, Adams DH, Abraham WT, Kappetein AP, Genereux P, Vranckx P, et al. Clinical trial design principles and endpoint definitions for transcatheter mitral valve repair and replacement: part 2: endpoint definitions: a consensus document from the Mitral Valve Academic Research Consortium. J Am Coll Cardiol. 2015;66:308–21.CrossRefPubMed
39.
Zoghbi WA, Adams D, Bonow RO, Enriquez-Sarano M, Foster E, Grayburn PA, et al. Recommendations for noninvasive evaluation of native valvular regurgitation: a report from the American Society of Echocardiography Developed in Collaboration with the Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr. 2017;30:303–71.CrossRefPubMed
40.
Altiok E, Becker M, Hamada S, Reith S, Marx N, Hoffmann R. Optimized guidance of percutaneous edge-to edge repair of the mitral valve using real-time 3-D transesophageal echocardiography. Clin Res Cardiol. 2011;100:675–81.CrossRefPubMed
41.
Marsan NA, Westenberg JJ, Ypenburg C, Delgado V, van Bommel RJ, Roes SD, et al. Quantification of functional mitral regurgitation by real-time 3D echocardiography: comparison with 3D velocity-encoded cardiac magnetic resonance. JACC Cardiovasc Imaging. 2009;2:1245–52.CrossRefPubMed
42.
Guerrero M, Dvir D, Himbert D, Urena M, Eleid M, Wang DD, et al. Transcatheter mitral valve replacement in native mitral valve disease with severe mitral annular calcification: results from the first multicenter global registry. JACC Cardiovasc Interv. 2016;9:1361–71.CrossRefPubMed
43.
Cheung A, Webb J, Verheye S, Moss R, Boone R, Leipsic J, et al. Short-term results of transapical transcatheter mitral valve implantation for mitral regurgitation. J Am Coll Cardiol. 2014;64:1814–9.CrossRefPubMed
44.
Muller DW, Farivar RS, Jansz P, Bae R, Walters D, Clarke A, et al., Tendyne Global Feasibility Trial I. Transcatheter mitral valve replacement for patients with symptomatic mitral regurgitation: a global feasibility trial. J Am Coll Cardiol. 2017;69:381–91.
45.
Blanke P, Naoum C, Dvir D, Bapat V, Ong K, Muller D, et al. Predicting LVOT obstruction in transcatheter mitral valve implantation: concept of the Neo-LVOT. JACC Cardiovasc Imaging. 2017;10:482–5.CrossRefPubMed
46.
47.
Blanke P, Dvir D, Cheung A, Ye J, Levine RA, Precious B, et al. simplified D-shaped model of the mitral annulus to facilitate CT-based sizing before transcatheter mitral valve implantation. J Cardiovasc Comput Tomogr. 2014;8:459–67.CrossRefPubMedPubMedCentral
48.
Blanke P, Dvir D, Cheung A, Levine RA, Thompson C, Webb JG, et al. Mitral annular evaluation with CT in the context of transcatheter mitral valve replacement. JACC Cardiovasc Imaging. 2015;8:612–5.CrossRefPubMed
49.
Mak GJ, Blanke P, Ong K, Naoum C, Thompson CR, Webb JG, et al. Three-dimensional echocardiography compared with computed tomography to determine mitral annulus size before transcatheter mitral valve implantation. Circ Cardiovasc Imaging. 2016;9
50.
Nishimura RA, Otto CM, Bonow RO, Carabello BA, Erwin JP, Fleisher LA, Jneid H, Mack MJ, McLeod CJ, O’Gara PT, Rigolin VH, Sundt TM and Thompson A. 2017 AHA/ACC focused update of the 2014 AHA/ACC guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines. 2017.
51.
Hamid NB, Khalique OK, Monaghan MJ, Kodali SK, Dvir D, Bapat VN, et al. Transcatheter valve implantation in failed surgically inserted bioprosthesis: review and practical guide to echocardiographic imaging in valve-in-valve procedures. JACC Cardiovasc Imaging. 2015;8:960–79.CrossRefPubMed
52.
Singh JP, Evans JC, Levy D, Larson MG, Freed LA, Fuller DL, et al. Prevalence and clinical determinants of mitral, tricuspid, and aortic regurgitation the Framingham Heart Study. Am J Cardiol. 1999;83:897–902.CrossRefPubMed
53.
Nath J, Foster E, Heidenreich PA. Impact of tricuspid regurgitation on long-term survival. J Am Coll Cardiol. 2004;43:405–9.CrossRefPubMed
54.
Topilsky Y, Nkomo VT, Vatury O, Michelena HI, Letourneau T, Suri RM, et al. Clinical outcome of isolated tricuspid regurgitation. JACC Cardiovasc Imaging. 2014;7:1185–94.CrossRefPubMed
55.
Badano LP, Agricola E, de Isla LP, Gianfagna P, Zamorano JL. Evaluation of the tricuspid valve morphology and function by transthoracic real-time three-dimensional echocardiography. Eur J Echocardiogr. 2009;10:477–84.CrossRefPubMed
56.
Addetia K, Yamat M, Mediratta A, Medvedofsky D, Patel M, Ferrara P, et al. Comprehensive two-dimensional interrogation of the tricuspid valve using knowledge derived from three-dimensional echocardiography. J Am Soc Echocardiogr. 2015;
57.
Hahn RT. State-of-the-art review of echocardiographic imaging in the evaluation and treatment of functional tricuspid regurgitation. Circ Cardiovasc Imaging. 2016;9
58.
•• Hahn RT, Abraham T, Adams MS, Bruce CJ, Glas KE, Lang RM, et al. Guidelines for performing a comprehensive transesophageal echocardiographic examination: recommendations from the American Society of Echocardiography and the Society of Cardiovascular Anesthesiologists. J Am Soc Echocardiogr. 2013;26:921–64. Excellent overview of complete transesophageal echocardiographic exam, which is the basis of procedural guidance CrossRefPubMed
59.
Nickenig G, Kowalski M, Hausleiter J, Braun D, Schofer J, Yzeiraj E, et al. Transcatheter treatment of severe tricuspid regurgitation with the edge-to-edge MitraClip technique. Circulation. 2017;135:1802–14.CrossRefPubMed
60.
Vismara R, Gelpi G, Prabhu S, Romitelli P, Troxler LG, Mangini A, et al. Transcatheter edge-to-edge treatment of functional tricuspid regurgitation in an ex vivo pulsatile heart model. J Am Coll Cardiol. 2016;68:1024–33.CrossRefPubMed
61.
62.
Ghanta RK, Chen R, Narayanasamy N, McGurk S, Lipsitz S, Chen FY, et al. Suture bicuspidization of the tricuspid valve versus ring annuloplasty for repair of functional tricuspid regurgitation: midterm results of 237 consecutive patients. J Thorac Cardiovasc Surg. 2007;133:117–26.CrossRefPubMed
63.
Hahn RT, Meduri CU, Davidson CJ, Lim S, Nazif TM, Ricciardi MJ, et al. Early feasibility study of a transcatheter tricuspid valve annuloplasty: SCOUT trial 30-day results. J Am Coll Cardiol. 2017;69:1795–806.CrossRefPubMed
64.
Campelo-Parada F, Perlman G, Philippon F, Ye J, Thompson C, Bedard E, et al. First-in-man experience of a novel transcatheter repair system for treating severe tricuspid regurgitation. J Am Coll Cardiol. 2015;66:2475–83.CrossRefPubMed
Metadata
Title
Role of Echocardiography in Transcatheter Valvular Heart Disease Interventions
Authors
Omar K. Khalique
Rebecca T. Hahn
Publication date
01-12-2017
Publisher
Springer US
Published in
Current Cardiology Reports / Issue 12/2017
Print ISSN: 1523-3782
Electronic ISSN: 1534-3170
DOI
https://doi.org/10.1007/s11886-017-0942-y

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