Lee Sang-Hyup, Oh Seunguk, Ko Young-Guk, Lee Yong-Joon, Lee Seung-Jun, Hong Sung-Jin, Ahn Chul-Min, Kim Jung-Sun, Kim Byeong-Keuk, Ko Kyu-Yong, Cho Iksung, Shim Chi Young, Hong Geu-Ru, Choi Donghoon, Hong Myeong-Ki
Division of Cardiology, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, Korea.
Department of Cardiology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea.
Korean Circ J. 2024 Feb;54(2):63-75. doi: 10.4070/kcj.2023.0195. Epub 2023 Nov 13.
Evidence regarding the efficacy and safety of intracardiac echocardiography (ICE) for guidance during transcatheter aortic valve replacement (TAVR) is limited. This study aimed to compare the clinical efficacy and safety of ICE versus transesophageal echocardiography (TEE) for guiding TAVR.
This prospective cohort study included patients who underwent TAVR from August 18, 2015, to June 31, 2021. Eligible patients were stratified by echocardiographic modality (ICE or TEE) and anesthesia mode (monitored anesthesia care [MAC] or general anesthesia [GA]). Primary outcome was the 1-year composite of all-cause mortality, rehospitalization for cardiovascular cause, or stroke, according to the Valve Academic Research Consortium-3 (VARC-3) definition. Propensity score matching was performed, and study outcomes were analyzed for the matched cohorts.
Of the 359 eligible patients, 120 patients were matched for the ICE-MAC and TEE-GA groups, respectively. The incidence of primary outcome was similar between matched groups (18.3% vs. 20.0%; adjusted hazard ratio, 0.94; 95% confidence interval [CI], 0.53-1.68; p=0.843). ICE-MAC and TEE-GA also had similar incidences of moderate-to-severe paravalvular regurgitation (PVR) (4.2% vs. 5.0%; adjusted odds ratio, 0.83; 95% CI, 0.23-2.82; p=0.758), new permanent pacemaker implantation, and VARC-3 types 2-4 bleeding.
ICE was comparable to TEE for guidance during TAVR for the composite clinical efficacy outcome, with similar incidences of moderate-to-severe PVR, new permanent pacemaker implantation, and major bleeding. These results suggest that ICE could be a safe and effective alternative echocardiographic modality to TEE for guiding TAVR.
关于心腔内超声心动图（ICE）在经导管主动脉瓣置换术（TAVR）中指导作用的有效性和安全性的证据有限。本研究旨在比较ICE与经食管超声心动图（TEE）在指导TAVR方面的临床有效性和安全性。
这项前瞻性队列研究纳入了2015年8月18日至2021年6月31日期间接受TAVR的患者。符合条件的患者根据超声心动图检查方式（ICE或TEE）和麻醉方式（监护麻醉[MAC]或全身麻醉[GA]）进行分层。主要结局是根据瓣膜学术研究联盟-3（VARC-3）定义的全因死亡率、心血管原因再住院或中风的1年复合结局。进行倾向得分匹配，并对匹配队列的研究结局进行分析。
在359例符合条件的患者中，分别为ICE-MAC组和TEE-GA组匹配了120例患者。匹配组之间的主要结局发生率相似（18.3%对20.0%；调整后的风险比，0.94；95%置信区间[CI]，0.53-1.68；p=0.843）。ICE-MAC组和TEE-GA组中重度瓣周反流（PVR）的发生率也相似（4.2%对5.0%；调整后的优势比，0.83；95%CI，0.23-2.82；p=0.758），新的永久性起搏器植入以及VARC-3 2-4型出血的发生率也相似。
在TAVR期间，就复合临床有效性结局而言，ICE与TEE在指导方面具有可比性，中重度PVR、新的永久性起搏器植入和大出血的发生率相似。这些结果表明，对于指导TAVR，ICE可能是一种安全有效的替代TEE的超声心动图检查方式。
