Preoperative TAVR Planning: How to Do It

Abstract

Transcatheter aortic valve replacement (TAVR) is a well-established treatment option for patients with severe symptomatic aortic stenosis (AS) whose procedural efficacy and safety have been continuously improving. Appropriate preprocedural planning, including aortic valve annulus measurements, transcatheter heart valve choice, and possible procedural complication anticipation is mandatory to a successful procedure. The gold standard for preoperative planning is still to perform a multi-detector computed angiotomography (MDCT), which provides all the information required. Nonetheless, 3D echocardiography and magnet resonance imaging (MRI) are great alternatives for some patients. In this article, we provide an updated comprehensive review, focusing on preoperative TAVR planning and the standard steps required to do it properly.

The Changing Complementary Role of Multimodality Imaging in Clinical Cardiology

“…Two-dimensional, three- dimensional and Doppler transthoracic and transoesophageal echocardiography are the first-line imaging modalities for the diagnostic and prognostic assessment of valvular heart disease (VHD), followed by cardiac magnetic resonance for tissue and flow characterization and the detection of myocardial and papillary muscle fibrosis [ 17 , 18 , 19 , 20 , 21 , 22 ]. Moreover, novel data have been reported on computed tomography and positron emission tomography utilizing 18F-fluorodeoxyglucose as a tool for providing evidence of early myocardial inflammation [ 17 , 18 , 19 , 20 , 21 , 22 ].…”

“…Two-dimensional, three- dimensional and Doppler transthoracic and transoesophageal echocardiography are the first-line imaging modalities for the diagnostic and prognostic assessment of valvular heart disease (VHD), followed by cardiac magnetic resonance for tissue and flow characterization and the detection of myocardial and papillary muscle fibrosis [ 17 , 18 , 19 , 20 , 21 , 22 ]. Moreover, novel data have been reported on computed tomography and positron emission tomography utilizing 18F-fluorodeoxyglucose as a tool for providing evidence of early myocardial inflammation [ 17 , 18 , 19 , 20 , 21 , 22 ]. The introduction of other imaging modalities in the diagnosis of VHD could significantly improve our knowledge concerning cardiac mechanics; the tissue characterization of the burden imposed by the myocardium, calcium and inflammation on valves; and their impact on the severity, progression and prognosis of VHD, not only in symptomatic, but also in asymptomatic patients [ 17 , 18 , 19 , 20 , 21 , 22 ].…”

“…Moreover, novel data have been reported on computed tomography and positron emission tomography utilizing 18F-fluorodeoxyglucose as a tool for providing evidence of early myocardial inflammation [ 17 , 18 , 19 , 20 , 21 , 22 ]. The introduction of other imaging modalities in the diagnosis of VHD could significantly improve our knowledge concerning cardiac mechanics; the tissue characterization of the burden imposed by the myocardium, calcium and inflammation on valves; and their impact on the severity, progression and prognosis of VHD, not only in symptomatic, but also in asymptomatic patients [ 17 , 18 , 19 , 20 , 21 , 22 ]. However, such a variety of novel parameters also brings uncertainty in regard to the clinical relevance of these indices, as well as the necessity for their validation in everyday practice.…”

“…However, such a variety of novel parameters also brings uncertainty in regard to the clinical relevance of these indices, as well as the necessity for their validation in everyday practice. If we were to be able to positively elaborate on the diagnostic challenges and outline potential advantages of comprehensive multimodality cardiac imaging, we could better identify patients that could benefit from specific surgical or transcatheter valve interventions, as well as parameters that may be of help during follow-ups, for a more personalized and precision medicine [ 17 , 18 , 19 , 20 , 21 , 22 ].…”

The Heart in the Transcatheter Intervention Era: Where Are We?

“…This Special Issue of the Journal of Clinical Medicine (JCM) entitled “Transcatheter Structural Heart Disease Interventions: Clinical Update” offers eight original articles and four review articles. Ten articles focus on the transcatheter aortic valve approach, discussing all the relevant issues related to this technique, such as balloon aortic valvoplasty [ 15 ]; TAVI indications and patient selection [ 16 ]; pre-procedural planning [ 17 ]; access routes (open or percutaneous vascular access) [ 18 ]; potential access-related complications [ 19 ]; TAVI outcomes compared with surgery [ 20 ]; challenges of surgery after TAVI failure [ 21 ]; post-TAVI prognostic factors [ 22 ]; potential benefits of cerebral embolic protection devices [ 23 ]; and the BASILICA technique to prevent coronary obstruction [ 24 ]. Three additional articles discuss the state of the art in transcatheter mitral valve replacement images [ 25 ]; atrial functional tricuspid regurgitation [ 26 ]; and the use of different diagnostic catheters for transradial coronary angiography [ 27 ].…”