Consistency of transesophageal echocardiography and angiography in grading (using the Valve Academic Research Consortium 3 criteria) of perivalvular regurgitation during transcatheter aortic valve replacement

The aim of this study was to evaluate the consistency between transesophageal echocardiography (TEE) and angiography in grading of paravalvular regurgitation (PVR) during transcatheter aortic valve replacement (TAVR) according to the Valve Academic Research Consortium 3 (VARC-3) criteria. 31 patients who underwent TEE and angiography during TAVR were retrospectively included. Circumferential extent of PVR, regurgitation volume, regurgitation fraction, and the effective regurgitant orifice area were measured by TEE. Weighted kappa coefficient was used to analyze the consistency of the two techniques. PVR was found in 16 of 31 patients. TEE assessed mild PVR in 14 cases and moderate PVR in 2 cases. Angiography assessed mild PVR in 12 cases and moderate PVR in 2 cases. The grading of TEE and angiography were the same in 29 cases, of which 15 were absent, 12 were mild, and 2 were moderate. The weighted kappa coefficient for both techniques was 0.88 (P < 0.001). The Kendall’s W coefficient of the circumferential extent of PVR, regurgitation volume, regurgitation fraction, and the effective regurgitant orifice area was 0.285 (P<0.005). TEE and angiography had strong consistency in the grading (using the VARC-3 criteria) of PVR during TAVR. TEE was a potential diagnostic tool for classifying PVR.