Point-of-Care Ultrasound Before and After Transfemoral Transcatheter Aortic Valve Implantation

Özet

Objective: Surgical aortic valve replacement requires a comprehensive transoesophageal echocardiography (TEE) assessment before andafter the intervention by cardiac anaesthesiologists. For patients undergoing transfemoral transcatheter aortic valve implantation (TF-TAVI),TEE is not routinely used. We started using transthoracic echocardiography (TTE) as a diagnostic and monitoring modality during TF-TAVIprocedures. The aim of this study is to examine the usefulness of TTE before and after TF-TAVI. We hypothesised that TTE can serve as ascreening tool in TF-TAVI patients and help rule out significant paravalvular leaks (PVLs), and serve as a monitoring tool.Methods: A retrospective, observational study of 24 patients who underwent TF-TAVI with perioperative TTE over a 3-month period wasconducted. Intraoperatively, two TTE examinations were performed. The first was a baseline pre-procedural TTE examination after anaesthetic induction, and the second was performed after TAVI valve implantation. Both pre- and post-procedural examinations included fivefocused TTE views. PVLs were graded as none, non-significant (trace or mild) or significant (moderate or severe).Results: The average age and median body mass index of the patients were 82 years and 28.5 kg m-2, respectively. The average time recordedfor the pre- and post-TAVI TTE examinations were approximately 4 and 5.5 min, respectively. Non-significant PVL was detected in 6 (25%)patients, and no leak was detected in 18 (75%) patients.Conclusion: A focused TTE examination was found to be a useful adjunct during TF-TAVI for a cardiac anaesthesiologist in the absenceof TEE, and useful in ruling out significant PVLs