Echocardiography Plays Vital Role in Planning, Execution and Follow-up of Transcatheter Aortic Valve Replacement

Current guidelines recommend a multidisciplinary approach as optimal for treating patients who qualify for transcatheter aortic valve replacement (TAVR).1 In addition to a care team of cardiac surgeons and interventional cardiologists, echocardiographers are involved in every phase of transcatheter valve replacement: from pre-implantation patient screening and selecting an appropriate valve size, to intraprocedural guidance of wire and valve position and post-implantation assessment.1

At Penn State Hershey Heart and Vascular Institute, patients first receive a transthoracic echocardiogram (TTE) to examine the aortic valve and quantify the degree of stenosis. Based on the combination of those results and other factors, high-risk patients who are not surgical candidates (due to multiple comorbidities) are referred for TAVR. “Further preparation involves several additional studies including a transesophageal echocardiogram (TEE) with three-dimensional (3D) imaging of the aortic root. This allows physicians to measure the aortic annulus and determine the appropriate size for the replacement valve,” says Michael Pfeiffer, M.D., Penn State Hershey Heart and Vascular Institute. TEE with 3D imaging also examines other aspects of the heart that may impact the TAVR procedure, such as the morphology of the left ventricular outflow track and aortic root, co-existing mitral valve disease and coronary artery position. Patients also receive multi-detector computed tomography (MDCT) evaluation as part of their pre-procedure assessment. Both imaging techniques are complementary pieces of the complete pre-implantation assessment.

Transcatheter Aortic Valve Replacement

3D image of aortic valve, primarily used to measure the aortic annulus and select the most appropriate size valve replacement.

During the TAVR procedure, echocardiographers use TEE to continually assess the heart, monitor its function, and provide live procedural guidance. The role of TEE immediately following TAVR is also critical, both for confirming successful valve deployment and excluding complications. In long-term follow-up, echocardiography remains the standard for monitoring prosthetic valves and cardiac function.

The multidisciplinary team approach to valve replacement helps facilitate success, as Penn State Hershey has seen over the last year, having completed more than 50 TAVR procedures with excellent results. “It makes a real difference to have a consistent group of doctors collaborating on every case and learning from the common experience,” says Pfeiffer. He adds, “This is an exciting time. The new technology drives us to hone our team approach and helps us collaborate to use the widest range of treatment options creating the best chance of success for our patients.”


Michael Pfeiffer, M.E.Michael Pfeiffer, M.D.
Assistant Professor, Medicine
Cardiologist
PHONE: 717-531-0003 ext. 284283
E-MAIL: mpfeiffer@hmc.psu.edu
FELLOWSHIP: Cardiovascular disease, Penn State Hershey Medical Center, Hershey, Pennsylvania
RESIDENCY: Internal medicine, Thomas Jefferson University, Philadelphia, Pennsylvania
MEDICAL SCHOOL: Thomas Jefferson University, Philadelphia, Pennsylvania


References:

  1. Hahn RT, Little SH, Monaghan MJ, Kodali SK, Williams M, Leon MB and Gillam LD. Recommendations for Comprehensive Intraprocedural Echocardiographic Imaging During TAVR. J Am Coll Cardiol Img 2015;8:261–87.

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