How accurate is intraprocedural transthoracic echocardiography in assessing aortic regurgitation after transcathether aortic valve implantation? A single center experience

Aim Transthoracic echocardiography (TTE) has been commonly used to assess the aortic regurgitation (AR), particularly paravalvular leakage, during transcatheter aortic valve implantation (TAVI). We sought to investigate the accuracy of intraprocedural TTE to grade the AR severity by comparing with discharge TTE assessments. Methods Consecutive patients received balloon expandable (BE) or self-expanding (SE) transcatheter heart valves with both intraprocedural TTE and discharge TTE AR assessments were included. The AR was assessed following the standard approach intraprocedurally by one dedicated interventional echocardiographer and at discharge by one echo-cardiologist. Results In total 404 patients, the AR grade was concordant in about 2/3 of the population and discordance was mainly underestimation of AR severity with intraprocedural TTE. None or trace intraprocedural AR was more seen in patients with BE valves and the concordance with discharge assessment was also higher in BE valve group than that of the SE valve group. The discordance was mainly underestimation too, regardless of valve types. Conclusion in our single-center real-world experience, the AR assessed with intraprocedural TTE was discordant with the discharge TTE in about 1/3 of the cases with predominantly underestimation.