Transcatheter aortic valve implantation under angiographic guidance with and without adjunctive transesophageal echocardiography

Guilherme F. Attizzani, Yohei Ohno, Azeem Latib, Anna Sonia Petronio, Marco De Carlo, Cristina Giannini, Federica Ettori, Salvatore Curello, Claudia Fiorina, Francesco Bedogni, Luca Testa, Giuseppe Bruschi, Federico De Marco, Patrizia Presbitero, Marco Luciano Rossi, Carla Boschetti, Silvia Picarelli, Arnaldo Poli, Marco Barbanti, Paola MartinaAntonio Colombo, Corrado Tamburino

Research output: Contribution to journalArticlepeer-review

24 Scopus citations

Abstract

Although transcatheter aortic valve implantation (TAVI) is still currently guided by transesophageal echocardiography (TEE) in a considerable number of hospitals, exclusive angiographic (Angio) guidance seems a reasonable approach in this setting. To date, however, no studies have directly compared the outcomes of TAVI according to the imaging modality used for procedural guidance. We, therefore, used data from a large multicenter data repository to compare the outcomes of TAVI guided exclusively by Angio and ATEE. All consecutive patients with severe aortic stenosis who underwent TAVI with the CoreValve Revalving System (CRS) in 9 Italian centers from September 2007 to March 2014, dichotomized according to the imaging support used to guide the procedure (ATEE and Angio), were included. Thirty-day and 12-month clinical outcomes were evaluated. Propensity matching analysis was performed to adjust for baseline differences. A total of 625 patients were included (256 and 369 patients were included in the ATEE and Angio groups, respectively). Patients from the ATEE more frequently underwent TAVI under general anesthesia compared with Angio group (37.9% vs 22.8%, respectively, p <0.001). Importantly, ∼80% of the patients experienced mild or even less aortic regurgitation as assessed by angiography after the procedure, without between-group differences. Postdilation and valve-in-valve rates were equivalent (24.7% vs 25%, p = 0.934 and 5.5% vs 3.4%, respectively, p = 0.217). No differences were revealed in the rates of death, cardiovascular death, and stroke or transient ischemic attack at 12-month follow-up. These results were sustained after propensity matching analysis. In conclusion, as long as a comprehensive procedural planning is performed, TAVI with CRS may be performed exclusively under angiographic guidance without the need for associated TEE.

Original languageEnglish (US)
Pages (from-to)604-611
Number of pages8
JournalAmerican Journal of Cardiology
Volume116
Issue number4
DOIs
StatePublished - Aug 15 2015
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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