Recommendations in pre-procedural imaging assessment for transcatheter aortic valve implantation intervention: Italian Society of Cardiology (SIC)–Italian Society of Medical and Interventional Radiology (SIRM) position paper part 1 (Clinical Indication and Basic Technical Aspects, Heart Team, Role of Echocardiography)

Abstract

Non-invasive cardiovascular imaging owns a pivotal role in the preoperative assessment of patients for transcatheter aortic valve implantation (TAVI), providing a wide range of crucial information to select the patients who will benefit the most and have the procedure done safely. Although advanced cardiac imaging with cardiac computed tomography is routinely used for a detailed anatomic assessment before TAVI, echocardiography remains the first imaging modality to assess aortic stenosis severity and to provide essential functional information. This document results from the collaboration between the Italian Society of Cardiology (SIC) and the Italian Society of Medical and Interventional Radiology (SIRM), aiming to produce an updated consensus statement about the preprocedural imaging assessment in patient for TAVI. The writing committee is composed of radiologists and cardiologists, experts in the field of cardiac imaging and structural heart diseases. Part 1 of the document, after a brief overview of the clinical indication and basic technical aspects of TAVI, will focus on the role of echocardiography in TAVI pre-procedural planning.

Acute expansion of nitinol-based self-expandable device in patients undergoing transfemoral aortic valve implantation

“…Valve size was selected based on aortic annulus measurements obtained by computed tomography (CT). 20 Patients' characteristics were collected and included in a dedicated database. Chronic kidney disease (CKD) was defined as abnormalities of kidney structure or function, present for more than 3 months, and that requires one of two criteria documented or inferred for more than 3 months: either glomerular filtration rate less than 60 ml/min/1.73 m 2 or markers of kidney damage, including albuminuria.…”

Large-bore sheath insertion using a slip-through technique in transcatheter aortic valve replacement

“…Our local multidisciplinary heart team performed transcatheter aortic valve replacement (TAVR) due to the high surgical risk (Society of Thoracic Surgeons-Predicted Risk of Mortality score, 9.723). 1 Computed tomography (CT) revealed a small aortic annulus (perimeter: 64.2 mm, area: 315.8 mm 2 ). We opted to use a SAPIEN 3 20 mm valve (Edwards Lifesciences, Irvine, California, USA), as this is the only reimbursed balloon-expandable valve for patients on dialysis in Japan, along with a 14 Fr expandable sheath (E-sheath Edwards Lifesciences) for delivery.…”

“…Transthoracic echocardiography revealed severe aortic stenosis. Our local multidisciplinary heart team performed transcatheter aortic valve replacement (TAVR) due to the high surgical risk (Society of Thoracic Surgeons–Predicted Risk of Mortality score, 9.723) 1 . Computed tomography (CT) revealed a small aortic annulus (perimeter: 64.2 mm, area: 315.8 mm 2 ).…”

Coronary occlusion after valve-in-valve transcatheter aortic valve replacement with bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) in a patient with narrow sinotubular junction

“…Coronary obstruction is a major complication of transcatheter aortic valve replacement (TAVR), associated with in-hospital mortality in over one-third of cases 1 . In spite of a low overall incidence, the risk of coronary obstruction becomes not negligible after valve-in-valve TAVR 2 and in the presence of specific anatomic risk features, such as low-lying coronary ostia, small valve to coronary (VTC) distance and low sinotubular junction (STJ) height 1,3,4 . BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR) has recently been introduced as an alternative to traditional snorkel stenting to prevent coronary obstruction in patients at high risk 5 …”

“…1 In spite of a low overall incidence, the risk of coronary obstruction becomes not negligible after valve-in-valve TAVR 2 and in the presence of specific anatomic risk features, such as low-lying coronary ostia, small valve to coronary (VTC) distance and low sinotubular junction (STJ) height. 1,3,4 BASILICA (bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR) has recently been introduced as an alternative to traditional snorkel stenting to prevent coronary obstruction in patients at high risk. 5 We present the case of a 78-year-old woman with degenerated 19-mm Trifecta aortic bioprothesis (St. Jude Medical, Inc., St. Paul, Minnesota, USA), resulting in severe aortic stenosis (maximum gradient, 63 mmHg; mean gradient, 43 mmHg; aortic valve area, 0.5 cm 2 ).…”