Application of Three-Dimensional Transesophageal Echocardiography in Preoperative Evaluation of Transcatheter Aortic Valve Replacement

Abstract BackgroundAnalysing the accuracy of 3D-TEE in preoperative evaluation of TAVR compared with CT when the error led by inconsistent software and method has been eliminated and the representativeness of sample has been improved, and exploring the influence of aortic root calcification on the accuracy of 3D-TEE in aortic annulus evaluations.MethodsPart I: 45 of 233 patients who underwent TAVR in the department of cardiovascular surgery in Xijing hospital from January 2016 to August 2019 were retrospectively studied. Mimics and multiplanar reconstruction method were used for evaluation based on 3D-TEE and CT. Annulus diameter - area derived (Da), annulus diameter - perimeter derived (Dp), annulus mean diameter, the left ventricular outflow tract (LVOT) diameter-Dp, the sinus tube junction (STJ) diameter-Dp and aortic sinus diameter were compared and analyzed. Part ii: 31 of 233 patients whose 3D-TEE and CT data were well preserved and in the required format were included. HU450 and HU850 were used as indicators to measure the severity of calcification, and spearman rank correlation and ROC curve was used to analyze the correlation between aortic root calcification and accuracy of 3D-TEE in aortic annulus measurement.ResultsThe measurement results based on 3D-TEE were significantly lower than those of CT (p<0.05), except for the STJ diameter-Dp in diastole (p=0.11). The correlation coefficient of the two groups was 0.699 ~ 0.954 (p < 0.01), which also indicated a significant correlation between the two groups.Bland-Altman plot showed that the ordinate values were mostly within the 95% consistency limit, the consistency of the two groups was good. By establishing the linear regression equation, the two groups can be inferred from each other. Spearman rank correlation analysis and ROC curve analysis showing that the influence of aortic calcification on the accuracy of 3D-TEE annulus evaluation was limited.ConclusionsWhlie evaluation based on 3D-TEE underestimated the results, we can deduce CT results from 3D-TEE as they obtain considerable correlation and consistency. Calcification in the aortic sinus did not affect the accuracy of 3D-TEE annulus evaluation.Trial registrationName: Surgery and Transcatheter Intervention for Structural Heart DiseasesNumber: NCT02917980URL : https://clinicaltrials.gov/ct2/results?term=NCT02917980