Insights from the assessment of anatomical valve orifice area after transcatheter aortic valve implantation using transesophageal echocardiography.

Transthoracic echocardiography (TTE) is the gold standard for evaluating aortic valve function after transcatheter aortic valve implantation (TAVI). However, it is known that the Doppler method using TTE tends to overestimate the mean pressure gradient (mPG) and underestimate the effective orifice area (EOA), leaving room for debate regarding the most accurate method for assessing aortic valve function after TAVI. This study compared transesophageal echocardiography (TEE) and TTE measurements of transcatheter aortic valve (TAV) area and explored factors influencing the area difference. The anatomically derived valve orifice area index (AOA-i), traced from TEE images, was compared to the effective orifice area index (EOA-i) obtained from TTE. This study screened 493 consecutive patients who underwent SAPIEN 3 valve implantation, of whom 464 met the inclusion criteria. AOA-i was significantly larger than EOA-i, and the two showed only a weak correlation. By TTE, 42 cases (9.1%) had mPG ≥ 20 mmHg, and 37 cases (7.5%) satisfied moderate prosthesis–patient mismatch (PPM) criteria, but no severe PPM was observed. No difference in AOA-i was observed between patients with mPG ≥ 20 mmHg and those with mPG < 20 mmHg. Multivariate analysis showed that female, low stroke volume index, larger TAV size, and higher left ventricular mass index were independently associated with greater discrepancy between TTE and TEE measurements. This study demonstrated that TTE may overestimate hemodynamic parameters after TAVI, suggesting that TTE alone may not always accurately reflect true valve function. Multifaceted evaluation is considered essential for accurately assessing TAV function and making appropriate clinical decisions.