Abstract 1395 Imaging strategies in tricuspid edge-to-edge intervention influence immediate procedural outcomes.

Background

Echocardiographic guiding gains importance as trans-catheter interventions for heart valve diseases advance. In transcatheter-edge-to-edge-repair for tricuspid regurgitation (TEER-TR), certain echocardiography imaging is suggested to optimally guide device-deployment. However, robust data on this, as well as on the role of fluoroscopy settings are missing.

Material & Methods

We retrospectively assessed the effect of different imaging strategies on immediate therapy effect ΔTR and on device-time in the TEER-TR interventions performed at our centre from July 2016 to December 2019.

Results

A total of 188 cases of TEER-TR procedures were conducted. Grasping was visualized using transesophageal imaging in 69 cases (mid-esophageal (MidE): n=47; deep-esophageal (DeepE): n=18; live-MPR: n=4). The transgastric view (TG) constituted the grasping-view 119 times. Best imaging qualities were observed in DeepE and TG (Figure 1). Imaging quality had a significant impact on the ΔTR. In cases of secondary TR, the use of TG was superior in achieving a ΔTR reduction of 2 or more grades. Both the use of TG and special fluoroscopy alignment significantly reduced the fluoroscopy and device time.

Conclusion

TEER-TR can be effectively guided using different echocardiographic strategies. Using the TG approach offers benefits in immediate procedural result and device time, with the latter further reduced using fluoroscopic alignment.

Conclusion

Figure 1:
Leaflet engagement displayed by 3D biplane echocardiography (A-B): In the transesophageal position – here deep-esophageal – the device is displayed from above (A). The left-hand image is a short axis plane, showing the RV inflow/outflow tract. The right hand image shows the perpendicular plane as defined by the turquoise line. Care must be taken to adjust the echocardiography planes, so that the device (*) is portrayed in its full extend to avoid misalignment. In the transgastric position, the device is displayed from below (B). The left hand image is a short axis, showing the „en-face“ view on the tricuspid valve. The device is rotated perpendicular to the coaptation line. Optimal display of the tricuspid valve is achieved when the level of leaflet coaptation is in the middle of the isonation beam (red transparent line).

Fluoroscopy pre-alignment (C-D): In panel C, the device is non-aligned, with the extend visible. After alignment (D), the device is displayed strictly from side to side.

Overall imaging quality (E): The MidE shows a normal distribution of imaging qualities with “moderate” as the mainly encountered grading. DeepE stands out by its very high number of “no imaging possible” image quality, showing the difficulty of this particular imaging window. The TG view shows the best imaging quality.

CAMEES-Score (F): Scoring of image quality in different TEE views, based on visibility of Chordae, Annulus, leaflet Mobility, leaflet Edges, and Extraordinary Shadowing.

Values are presented as median [Q1, Q3] or as absolute values ( %), or as absolute values only.

Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5
Imaging strategies in tricuspid edge-to-edge intervention influence immediate procedural outcomes.
T. Ruf¹, P. Gerdes¹, F. Kreidel¹, W. Ali², O. Hahad¹, J. G. da Rocha e Silva¹, A. R. Tamm¹, M. Geyer¹, T. Münzel¹, R. S. von Bardeleben¹
¹Kardiologie 1, Zentrum für Kardiologie, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz; ²Montreal Heart Institute, Université de Montréal, Montréal, CA;
Background Echocardiographic guiding gains importance as trans-catheter interventions for heart valve diseases advance. In transcatheter-edge-to-edge-repair for tricuspid regurgitation (TEER-TR), certain echocardiography imaging is suggested to optimally guide device-deployment. However, robust data on this, as well as on the role of fluoroscopy settings are missing. Material & Methods We retrospectively assessed the effect of different imaging strategies on immediate therapy effect ΔTR and on device-time in the TEER-TR interventions performed at our centre from July 2016 to December 2019. Results A total of 188 cases of TEER-TR procedures were conducted. Grasping was visualized using transesophageal imaging in 69 cases (mid-esophageal (MidE): n=47; deep-esophageal (DeepE): n=18; live-MPR: n=4). The transgastric view (TG) constituted the grasping-view 119 times. Best imaging qualities were observed in DeepE and TG (Figure 1). Imaging quality had a significant impact on the ΔTR. In cases of secondary TR, the use of TG was superior in achieving a ΔTR reduction of 2 or more grades. Both the use of TG and special fluoroscopy alignment significantly reduced the fluoroscopy and device time. Conclusion TEER-TR can be effectively guided using different echocardiographic strategies. Using the TG approach offers benefits in immediate procedural result and device time, with the latter further reduced using fluoroscopic alignment. Conclusion TEER-TR can be effectively guided using different echocardiographic strategies. Using the TG approach offers benefits in immediate procedural result and device time, with the latter further reduced using fluoroscopic alignment. Figure 1: Leaflet engagement displayed by 3D biplane echocardiography (A-B): In the transesophageal position – here deep-esophageal – the device is displayed from above (A). The left-hand image is a short axis plane, showing the RV inflow/outflow tract. The right hand image shows the perpendicular plane as defined by the turquoise line. Care must be taken to adjust the echocardiography planes, so that the device (*) is portrayed in its full extend to avoid misalignment. In the transgastric position, the device is displayed from below (B). The left hand image is a short axis, showing the „en-face“ view on the tricuspid valve. The device is rotated perpendicular to the coaptation line. Optimal display of the tricuspid valve is achieved when the level of leaflet coaptation is in the middle of the isonation beam (red transparent line). Fluoroscopy pre-alignment (C-D): In panel C, the device is non-aligned, with the extend visible. After alignment (D), the device is displayed strictly from side to side. Overall imaging quality (E): The MidE shows a normal distribution of imaging qualities with “moderate” as the mainly encountered grading. DeepE stands out by its very high number of “no imaging possible” image quality, showing the difficulty of this particular imaging window. The TG view shows the best imaging quality. CAMEES-Score (F): Scoring of image quality in different TEE views, based on visibility of Chordae, Annulus, leaflet Mobility, leaflet Edges, and Extraordinary Shadowing. MidE, mid-esophageal view; DeepE. Deep-esophageal view; TG, transgastric view. Values are presented as median [Q1, Q3] or as absolute values ( %), or as absolute values only.
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