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Left ventricular outflow tract shape after aortic valve replacement with St. Jude Trifecta prosthesis
Author(s) -
Barletta Giuseppe,
Venditti Francesco,
Stefano Pierluigi,
Del Bene Riccarda,
Di Mario Carlo
Publication year - 2018
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13778
Subject(s) - ventricular outflow tract , cardiology , medicine , prosthesis , aortic valve replacement , aortic valve , stenosis , stroke volume , aortic valve stenosis , surgery , ejection fraction , heart failure
Background Aortic prosthesis area ( EOA ) is computed by continuity equation from left ventricular ( LV ) stroke volume ( SV ) derived from LV outflow tract diameter ( LVOT D ) or, when unmeasurable, from LV volumes ( SV V ). There is evidence to suggest LVOT ellipticity and recommend 3D LVOT area ( LVOT CSA ) adoption in aortic stenosis. We sought to evaluate if the same concept applies to supra‐annular aortic prosthesis comparing SV and EOA derived from LVOT D ( EOA D ) and from LVOT CSA ( EOA CSA ). EOA computed from SV V ( EAO V ) accuracy was evaluated in this setting. Patient‐prosthesis mismatch ( PPM ) was compared among different EOA computations. Methods A consecutive series of 202 patients (aged 81 ± 4 years, 43% males) underwent St.Jude Trifecta aortic valve replacement ( AVR ) and were followed up with echocardiography at one‐year (335 ± 31 days). All measurements followed the EACVI or ASE guidelines, 3D X‐plane modality was used to compute SV v and measure LVOT CSA ; SV was calculated from LVOT D ( SV D ) and LVOT CSA ( SV CSA ). PPM was indexed EOA <0.65 cm²/m². Results LVOT showed a significant ellipticity index (1.17 ± .27), independent of prosthesis size. EOA D (1.70 ± 0.55 cm²) was less than EOA CSA (1.95 ± 0.62 cm²) ( P < .0001). SV V was significantly lower than SV D and SV CSA . Bland–Altman analysis showed a significant correlation between SV V and SV D or SV CSA although with large bias and imprecision. The correlations improved reducing bias and imprecision when LVOT time–velocity integral was <20 cm. PPM incidence was higher in EOA V (15.6%) compared to EOA D ( P = .04) or EOA CSA ( P < .001). Conclusions In supra‐annular AVR , LVOT retains its elliptical shape and LVOT CSA yielded larger prosthesis EOA with lower PPM incidence. PPM may be overestimated by EOA V .