A guide for pre-procedural imaging for transcatheter aortic valve replacement patients

Abstract

Safe and accurate pre-procedural assessment of cardiovascular anatomy, physiology, and pathophysiology prior to TAVR procedures can mean the difference between success and catastrophic failure. It is imperative that clinical care team members share a basic understanding of the preprocedural imaging technologies available for optimizing the care of TAVR patients. Herein, we review current imaging technology for assessing the anatomy, physiology, and pathophysiology of the aortic valvular complex, ventricular function, and peripheral vasculature, including echocardiography, cardiac catheterization, cardiac computed tomography, and cardiac magnetic resonance prior to a TAVR procedure. The authorship includes cardiac-trained anesthesiologists, anesthesiologists with expertise in pre-procedural cardiac assessment and optimization, and interventional cardiologists with expertise in cardiovascular imaging prior to TAVRs. Improving the understanding of all team members will undoubtedly translate into safer, more coordinated patient care.

Impact of transradial versus transfemoral access for preprocedural coronary angiography on TAVR-associated complications

“…Although, transradial access is considered the default approach for cardiac catheterization in most countries and recommended by the recent guidelines, strategies in patients receiving preprocedural coronary angiography for the preoperative management of valvular heart disease still varies significantly between centers [11] , [17] , [18] , [19] , [24] . This may be a consequence of the fact that, despite standardized use of reconstructed computed tomographic images for the assessment of the access vessel diameters and calcification in most centers, aorto-iliofemoral angiography is still a part of the preprocedural diagnostic setting in patients with severe aortic stenosis, which may lead to a preference of the transfemoral access [25] , [26] , [27] . However, it must be considered, that these patients undergo a repetitive iatrogenic injury of the access site in relatively quick succession.…”

Comparison of outcomes after transcatheter aortic valve replacement between elderly (65–79 years) and super-elderly (≥80 years) patients

“…Hence, coronary angiography is also routinely performed to confirm the presence and assess the severity of coronary artery disease. [ 16 ]…”

“…Hence, coronary angiography is also routinely performed to confirm the presence and assess the severity of coronary artery disease. [16] For each eligible patient, a multidisciplinary heart team, comprising interventional cardiologists, imaging cardiologists, cardiothoracic surgeons, and anesthesiologists, made decisions regarding the eligibility and feasibility of TAVR. The Society of Thoracic Surgeons Predicted Risk of Mortality (STS-PROM) and European System for Cardiac Operative Risk Evaluation II (EuroSCORE II) scores were used to estimate the perioperative risk of TAVR.…”

Computed Tomography and Magnetic Resonance Imaging Findings of Bicuspid Aortic Valve and Related Abnormalities of the Heart and Thoracic Aorta

“…Severe AV calcification is a contraindication to transcatheter aortic valve replacement (TAVR) because of the risk of annular rupture, inadequate prosthetic anchorage, and calcific embolism [ 15 ]. CCT plays an essential role in planning surgical/transcatheter aortic valve replacement (AVR) as it allows for the measurement of the dimensions of the virtual basal ring of the aortic annulus and helps delineate the vascular access routes [ 16 ]. CCT can be used as an alternative to invasive angiography before AVR is performed because of the high prevalence of CAD in patients with severe AS.…”