Immediate and long-term echocardiographic findings after transcatheter aortic valve implantation for the treatment of aortic stenosis: the Cribier-Edwards/Edwards-Sapien valve experience

Background: The role of transcatheter aortic valve implantation in the treatment of calcific aortic stenosis is evolving. Immediate and long-term echocardiographic findings are poorly reported.

Methods: Eighty-eight patients in whom surgical aortic valve replacement was contraindicated were studied before and 1 and 7 days, 1 month, and 1 and 2 years after the transcatheter procedure by echocardiography for hemodynamic. Transaortic pressure gradient, permeability index, and aortic valve area were measured, and aortic regurgitation was estimated from a multiparametric approach. A subset group of 36 patients (23-mm valve, n = 18; 26-mm valve, n = 18) with optimal ultrasound window were investigated for valve geometry at 7 days. We measured the sphericity index (anteroposterior to sagittal diameter ratio) and the angulation of the prosthesis with the ascending aorta.

Results: By analysis of variance, transaortic pressure gradient significantly decreased and aortic valve area increased after the procedure (P < .0001 and P < .0001 respectively). Aortic regurgitation severity tended to decline at follow-up (P = .20) and was unaffected by valve size (P = .35). Leaks were paraprosthetic in 77% of cases, intraprosthetic in 6% of cases, and both in 17% of cases. Overall, the sphericity index was 1.03 +/- 0.07 and the angulation was 2.9 +/- 1.1 degrees.

Conclusion: Echocardiography aids in the demonstration of appropriate prosthesis function and positioning after transcatheter aortic valve implantation.