Quantitative aortography for assessment of aortic regurgitation in the era of percutaneous aortic valve replacement

Mahmoud Abdelshafy, Patrick W. Serruys, Tsung Ying Tsai, Pruthvi Chenniganahosahalli Revaiah, Scot Garg, Jean Paul Aben, Carl J. Schultz, Mohammad Abdelghani, Pim A.L. Tonino, Yosuke Miyazaki, Marcel C.M. Rutten, Martijn Cox, Cherif Sahyoun, Justin Teng, Hiroki Tateishi, Mohamed Abdel-Wahab, Nicolo Piazza, Michele Pighi, Rodrigo Modolo, Martijn van MourikJoanna Wykrzykowska, Robbert J. de Winter, Pedro A. Lemos, Fábio S. de Brito, Hideyuki Kawashima, Lars Søndergaard, Liesbeth Rosseel, Rutao Wang, Chao Gao, Ling Tao, Andreas Rück, Won Keun Kim, Niels van Royen, Christian J. Terkelsen, Henrik Nissen, Matti Adam, Tanja K. Rudolph, Hendrik Wienemann, Ryo Torii, Franz Josef Neuman, Simon Schoechlin, Mao Chen, Ahmed Elkoumy, Hesham Elzomor, Ignacio J. Amat-Santos, Darren Mylotte, Osama Soliman, Yoshinobu Onuma

Research output: Contribution to journalReview articlepeer-review


Paravalvular leak (PVL) is a shortcoming that can erode the clinical benefits of transcatheter valve replacement (TAVR) and therefore a readily applicable method (aortography) to quantitate PVL objectively and accurately in the interventional suite is appealing to all operators. The ratio between the areas of the time-density curves in the aorta and left ventricular outflow tract (LVOT-AR) defines the regurgitation fraction (RF). This technique has been validated in a mock circulation; a single injection in diastole was further tested in porcine and ovine models. In the clinical setting, LVOT-AR was compared with trans-thoracic and trans-oesophageal echocardiography and cardiac magnetic resonance imaging. LVOT-AR > 17% discriminates mild from moderate aortic regurgitation on echocardiography and confers a poor prognosis in multiple registries, and justifies balloon post-dilatation. The LVOT-AR differentiates the individual performances of many old and novel devices and is being used in ongoing randomized trials and registries.

Original languageEnglish
Article number1161779
JournalFrontiers in Cardiovascular Medicine
Publication statusPublished - 2023

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