Quantitative aortography assessment of aortic regurgitation

EuroIntervention Journal

Transcatheter aortic valve implantation (TAVI) is undeniably invading the “surgical” space and expanding its indication. Over the last five years, there has been a real revolution in TAVI technology with the introduction of newer devices that aimed to simplify the procedure. These swift advances have transformed the landscape in structural heart disease and culminated in a broader use of TAVI in clinical practice. The procedure is not only spreading worldwide but is also becoming less aggressive for the patient with the so-called “minimalist approach”.

With the rise and consolidation of this minimally invasive era of TAVI procedures, precluding general anaesthesia, the use of transoesophageal (TEE) or transthoracic echocardiogram (TTE) during the procedure becomes restricted. However, a thorough assessment for (paravalvular) aortic regurgitation (AR) is important immediately post TAVI, since more than mild AR affects short- and long-term clinical outcomes and can be corrected during the procedure (e.g., with a valve-in-valve implant, balloon post-dilatation or even snaring) or even in the chronic stage (percutaneous closure of paravalvular leak)7. Thus, aortography (re-)emerges as a valuable tool for periprocedural AR assessment, as a surrogate technique of AR assessment, whenever transthoracic echocardiography is not available or doable in the interventional suite.
The low reproducibility of Sellers criteria8, a subjective method to quantify AR, begets the need for an objective and precise quantification of AR such as that provided by videodensitometry (VD). This objective method relies on aortography and can accurately quantify the transvalvular or paravalvular AR.
The quantitative AR assessment using the aortogram with VD was tested in vitro, in animal models and validated in clinical trial and real-world populations, evaluated in comparison either with echocardiography or with magnetic resonance imaging.

In this “insight” review the authors describe the evolution of this novel technique towards its complete validation in the clinical setting for TAVI, as well as the present and future application of the method in clinical trials and in the assessment of regurgitation in other valve procedures, such as mitral and tricuspid.

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