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OBJECTIVE: Aortic regurgitation (AR) is a possible complication following transcatheter aortic valve implantation (TAVI) which is associated with less-favourable outcome. Quantification of total regurgitation caused by multiple, multidirectional jets remains controversial.The purpose of this study is to assess the usefulness of retrograde contrast echocardiography in quantification of total AR following TAVI and to evaluate its prognostic significance.
METHODS: In 245 patients following Edwards Sapien valve (Edwards Lifesciences, Irvine, CA) implantation, we performed retrograde contrast transesophageal echocardiography to quantify AR immediately after TAVI. The contrast (20 mL agitated gelatine polysuccinate, Gelafundin 4%, Braun, Melsungen, Germany) was injected as a bolus into the sinotubular junction of the aorta through a pigtail catheter. We measured the area of the regurgitant cloud during mid to end-diastole. A regurgitant area ≥ 3.8 cm² was determined as an indicator of less favourable outcome. To assess whether AR identified by this novel method independently determined survival, a multivariate model was applied.
RESULTS: Contrast echocardiography recognised 56 patients with relevant regurgitation. Multivariate analysis including regurgitant area ≥ 3.8 cm², NYHA class IV, age, and creatinine concentration identified regurgitant area ≥ 3.8 cm² (p=0.027) as independent risk factor for 2-year survival.
CONCLUSIONS: Contrast echocardiography is a simple method for quantification of total AR following TAVI and could serve in the future as objective method to compare AR after implantation of different valves. Its clinical relevance is demonstrated by the impact of the AR detected by contrast echocardiography on survival.