Role of Preprocedural Computed Tomography in Transcatheter Aortic Valve Implantation

Abstract

Transcatheter aortic valve implantation (TAVI) is currently considered an acceptable alternative for the treatment of patients with severe aortic stenosis and a high perioperative risk or a contraindication for open surgery. The benefit of TAVI significantly outweighs the risk of the procedure in patients requiring treatment that are not suitable for open surgery, and leads to a lower mortality in the one-year follow-up.?The absence of a direct view of the aortic root and valve remains a challenge for the transcatheter approach. While direct inspection of the aortic valve during open surgery allows an adequate prosthesis choice, it is crucial for TAVI to know the individual anatomical details prior to the procedure in order to assure adequate planning of the procedure and proper prosthesis choice and patient selection. Among the imaging modalities available for the evaluation of patients prior to TAVI, computed tomography (CT) plays a central role in patient selection. CT reliably visualizes the dimensions of the aortic root and allows a proper choice of the prosthesis size. The morphology of the access path and relevant comorbidities can be assessed. The present review summarizes the current state of knowledge regarding the value of CT in the evaluation of patients prior to TAVI. Key Points: Citation Format:

International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches

“…Therefore, a computed tomographic (CT) scan providing sufficient resolution with expertise in the interpretation is recommended besides the classical diagnostics as transthoracic echocardiography and coronary angiography used to verify the indication, and exclude patients with additional cardiac pathologies requiring a different surgical approach. This way the ascending aorta can be displayed, and a proper planning of aortotomy with respect to annular diameter can be performed, as well as a proper size estimate and a closer analysis of the extent of calcification of the ascending aorta 29. Additionally, the CT scan is useful for the location of coronary ostia, the definition of the aortic root geometry, especially with respect to the relation between aortic annulus and sinotubular junction, for the identification of the type of bicuspid valve, if present, and for the positioning of the aortic root in relation to the sternum and the second right intercostal space.…”

Diagnosis and Treatment of Insufficient Dialysis Vascular Access

“…Examination should be performed in two consecutive contrast-enhanced series in the arterial and venous phase. Approximately 40 -60 ml of contrast agent are sufficient for modern CT protocols [45]. In particular, central venous thromboses can be effectively detected with CT ( • " Fig.…”

International Expert Consensus on Sutureless and Rapid Deployment Valves in Aortic Valve Replacement Using Minimally Invasive Approaches

“…This way the ascending aorta can be displayed, and a proper planning of aortotomy with respect to annular diameter can be performed, as well as a proper size estimate and a closer analysis of the extent of calcification of the ascending aorta. 29 Additionally, the CT scan is useful for the location of coronary ostia, the definition of the aortic root geometry, especially with respect to the relation between aortic annulus and sinotubular junction, for the identification of the type of bicuspid valve, if present, and for the positioning of the aortic root in relation to the sternum and the second right intercostal space. In case of renal failure or allergies to contrast media, native CT scan 30 or reduced dosage of contrast media 31 may be sufficient for most scenarios.…”