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Echocardiographic parameters predicting acute hemodynamically significant mitral regurgitation during transfemoral transcatheter aortic valve replacement
Author(s) -
Ito Asahiro,
Iwata Shinichi,
Mizutani Kazuki,
in Shinichi,
Nishimura Shinsuke,
Takahashi Yosuke,
Yamada Tokuhiro,
Murakami Takashi,
Shibata Toshihiko,
Yoshiyama Minoru
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.13792
Subject(s) - medicine , cardiology , ventricle , mitral regurgitation , hemodynamics , valve replacement , mitral valve , stenosis
Background Alteration in mitral valve morphology resulting from retrograde stiff wire entanglement sometimes causes hemodynamically significant acute mitral regurgitation ( MR ) during transfemoral transcatheter aortic valve replacement ( TAVR ). Little is known about the echocardiographic parameters related to hemodynamically significant acute MR . Methods and Results This study population consisted of 64 consecutive patients who underwent transfemoral TAVR . We defined hemodynamically significant acute MR as changes in the severity of MR with persistent hypotension (systolic blood pressure < 80–90 mm Hg or mean arterial pressure 30 mm Hg lower than baseline). Hemodynamically significant acute MR occurred in 5 cases (7.8%). Smaller left ventricular end‐systolic diameter ( LVD s), larger ratios of the coiled section of stiff wire tip to LVD s (wire‐width/ LVD s), and higher Wilkins score were significantly associated with hemodynamically significant acute MR ( P < .05), whereas the parameters of functional MR (annular area, anterior‐posterior diameter, tenting area, and coaptation length) were not. Moreover, when patients were divided into 4 groups according to wire‐width/ LVD s and Wilkins score, the group with the larger wire‐width/ LVD s and higher Wilkins score improved prediction rates ( P < .05). Conclusions Small left ventricle or wire oversizing and calcific mitral apparatus were predictive of hemodynamically significant acute MR . These findings are important for risk stratification, and careful monitoring using intraoperative transesophageal echocardiography may improve the safety in this population.