Quantitative aortography for assessment of aortic regurgitation in the era of percutaneous aortic valve replacement

• Published in: Frontiers in cardiovascular medicine 2023, Vol.10, p.1161779
• Main Authors: Abdelshafy, Mahmoud, Serruys, Patrick W, Tsai, Tsung-Ying, Revaiah, Pruthvi Chenniganahosahalli, Garg, Scot, Aben, Jean-Paul, Schultz, Carl J, Abdelghani, Mohammad, Tonino, Pim A L, Miyazaki, Yosuke, Rutten, Marcel C M, Cox, Martijn, Sahyoun, Cherif, Teng, Justin, Tateishi, Hiroki, Abdel-Wahab, Mohamed, Piazza, Nicolo, Pighi, Michele, Modolo, Rodrigo, van Mourik, Martijn, Wykrzykowska, Joanna, de Winter, Robbert J, Lemos, Pedro A, de Brito, Jr, Fábio S, Kawashima, Hideyuki, Søndergaard, Lars, Rosseel, Liesbeth, Wang, Rutao, Gao, Chao, Tao, Ling, Rück, Andreas, Kim, Won-Keun, van Royen, Niels, Terkelsen, Christian J, Nissen, Henrik, Adam, Matti, Rudolph, Tanja K, Wienemann, Hendrik, Torii, Ryo, Josef Neuman, Franz, Schoechlin, Simon, Chen, Mao, Elkoumy, Ahmed, Elzomor, Hesham, Amat-Santos, Ignacio J, Mylotte, Darren, Soliman, Osama, Onuma, Yoshinobu
• Format: Article
• Language: English
• Subjects: aortic regurgitation; Cardiovascular Medicine; Medicin och hälsovetenskap; paravalvular leak; quantitative aortography; transcatheter aortic valve implantation; transcatheter aortic valve replacement; videodensitometry
• ISSN: 2297-055X; 2297-055X
• DOI: 10.3389/fcvm.2023.1161779

Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models. In the clinical setting, LVOT-AR was compared with trans-thoracic and trans-oesophageal echocardiography and cardiac magnetic resonance imaging. LVOT-AR > 17% discriminates mild from moderate aortic regurgitation on echocardiography and confers a poor prognosis in multiple registries, and justifies balloon post-dilatation. The LVOT-AR differentiates the individual performances of many old and novel devices and is being used in ongoing randomized trials and registries.