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Comparison of transesophageal and transthoracic echocardiography under moderate sedation for guiding transcatheter aortic valve replacement

Echo Research & Practice volume 5, pages 79–87 (2018)Cite this article

Abstract

The optimal periprocedural imaging strategy during transcathether aortic valve replacement (TAVR) performed under moderate sedation is debated. Transthoracic echocardiography (TTE) provides suboptimal views due to poorer resolution and patient positioning, whereas use of transesophageal echocardiography (TEE) under moderate sedation is not widely utilized. The aim of our study was to compare the value of TTE in comparison with TEE guidance under moderate sedation during TAVR. The study population included 144 consecutive patients (mean age 83 ± 11 years, 78 (54%) females) who had TAVR under moderate sedation using either a TTE (n = 96) or TEE (n = 48). We compared procedural outcomes using propensity score matching. There were no significant inter-group differences in age, sex, ejection fraction, aortic valve area, pressure gradients, creatinine or type of valve used. The procedural time was significantly shorter in the TEE group (P < 0.001) and associated with a lower need for periprocedural aortograms (7.7 ± 1.9 vs 8.2 ± 1.9, P = 0.022) and a lower occurrence of acute kidney injury (1 vs 11, P = 0.047). The 1:1 propensity score matching also showed a lower procedural time (P = 0.032), number of aortograms (P = 0.014) and a trend toward lower acute kidney injury in the TEE group (P = 0.077). TAVR guidance using TEE is associated with a lower fluoroscopic time, a lower need for additional aortograms and trend in lower occurrence of post-TAVR acute kidney injury.

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Acknowledgments

The authors would like to acknowledge Dr. Sunil K Agarwal for his assistance in data analysis and statistics.

Funding

This work did not receive any specific grant from any funding agency in the public, commercial, or not-for-profit sector.

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Author notes

  1. (I Sherifi and A M S Omar contributed equally to this work)

Authors and Affiliations

  1. Division of Cardiology, Weill Cornell Medical Center, New York, New York, USA

    Ines Sherifi MD

  2. Division of Cardiology, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Ines Sherifi MD, Alaa Mabrouk Salem Omar MD PhD, Mithun Varghese MD, Jason C. Kovacic MD PhD, Samin Sharma MD, Annapoorna Kini MD & Partho P. Sengupta MD

  3. Department of Internal Medicine, Bronx Lebanon Hospital Center, New York, New York, USA

    Alaa Mabrouk Salem Omar MD PhD

  4. Department of Internal Medicine, Medical Division, National Research Center, Cairo, Egypt

    Alaa Mabrouk Salem Omar MD PhD

  5. Division of Anesthesia, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, Egypt

    Menachem Weiner MD

  6. Division of Cardiothoracic Surgery, Mount Sinai Hospital and Icahn School of Medicine at Mount Sinai, New York, New York, USA

    Ani Anyanwu MD

  7. WVU Heart & Vascular Institute, University of West Virginia, Morgantown, West Virginia, USA

    Partho P. Sengupta MD

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Sherifi, I., Omar, A.M.S., Varghese, M. et al. Comparison of transesophageal and transthoracic echocardiography under moderate sedation for guiding transcatheter aortic valve replacement. Echo Res Pract 5, 79–87 (2018). https://doi.org/10.1530/ERP-17-0080

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Echo Research & Practice

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