From the Guidelines
A repeat echocardiogram after transcatheter aortic valve replacement (TAVR) should be performed at 30 days post-procedure and then annually thereafter to monitor for complications and guide medical therapy. This recommendation is based on the 2017 ACC expert consensus decision pathway for TAVR in the management of adults with aortic stenosis, which emphasizes the importance of echocardiography in monitoring transcatheter valve function and detecting potential complications 1. The first post-discharge echo at 30 days is crucial to establish a new baseline for valve function and to detect any early complications, such as paravalvular leaks or valve thrombosis.
Key elements to be assessed during the repeat echocardiogram include:
- Valve hemodynamics (mean gradient, effective orifice area)
- Evaluation of regurgitation
- Assessment of left and right ventricular function
- Evaluation of mitral valve anatomy and function
- Estimation of pulmonary pressures
- Evaluation of the right ventricle
More frequent echocardiograms may be necessary if there are concerning symptoms such as shortness of breath, chest pain, syncope, or if there were complications during the initial procedure 1. The long-term durability of transcatheter bioprosthetic valves is not yet known, so annual evaluation for regurgitation, stenosis, and leaflet calcification or thrombosis is appropriate 1.
The monitoring schedule is essential because early detection of valve dysfunction allows for timely intervention, potentially preventing more serious complications and improving long-term outcomes after TAVR. Additionally, periodic echocardiography allows optimization of medical therapy for concurrent cardiac conditions, such as left ventricular dysfunction, coronary disease, and pulmonary hypertension 1.
From the Research
Post-TAVR Echocardiogram Results
The results of a repeat echocardiogram post Transcatheter Aortic Valve Replacement (TAVR) can be summarized as follows:
- Echocardiography is used to assess prosthetic valve function, left ventricular functional recovery, and the impact of the procedure on associated conditions such as mitral regurgitation, pulmonary hypertension, or tricuspid regurgitation 2
- Post-TAVR echo assessment should allow prompt recognition of early complications and the severity of para-valvular leaks 2
- Device landing zone calcification predicts significant paravalvular regurgitation after TAVR, which can be evaluated by real-time three-dimensional transesophageal echocardiography 3
- Echocardiographic follow-up after TAVR is crucial to detect long-term complications such as infective endocarditis, thrombosis, and to assess the structural and functional status of bioprostheses used in TAVR 4
Parameters Assessed by Echocardiogram
The following parameters are assessed by echocardiogram post-TAVR:
- Left ventricular ejection fraction (LVEF) 5, 6
- Left ventricular mass and wall thickness 5
- Global longitudinal strain (GLS) 5
- Paravalvular leak (PVL) 5
- Mean gradient (MG) 6
- Transaortic flow/Stroke Volume Index (SVI) 6
- Dimensional index (DI) 6
- Aortic valve area (AVA) 6
- Maximum velocity (V max) 6
Impact of Paravalvular Leak on Left Ventricular Remodeling
Paravalvular leak (PVL) can impede reverse left ventricular remodeling but not global longitudinal strain improvement 1-year after TAVR 5
- Patients without PVL had significant LVEF, wall thickness, and LV mass improvement compared to patients with PVL 5
- Diastolic function worsened in patients with PVL 5
Predictors of Long-Term Outcomes
The following parameters are associated with long-term outcomes after TAVR: