Figure - available from: Journal of Cardiac Surgery
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Agatston scoring in aortic stenosis. A patient presenting with symptomatic aortic stenosis and echocardiographic measurements of only moderate aortic stenosis: mean gradient 28 mmHg, jet velocity 3.5 m/s, aortic valve area 1.2 cm². TAVR CT reveals a severely calcified tricuspid aortic valve with an Agatston calcium score of 4555 confirming severe aortic stenosis.
Source publication
Transcatheter aortic valve replacement (TAVR) has transformed the treatment of aortic stenosis and pre‐procedure planning relies heavily on advanced imaging. Multidetector computed tomography angiography, the “TAVR CT,” facilitates essential planning steps of measuring the aortic root for valve sizing and feasibility and assessment of potential acc...
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Purpose:
The aim of our study was to evaluate the prevalence of early complications after Transcatheter Aortic Valve Implantation (TAVI) and their correlation with the Calcium Score (CS) of the aortic valve, aorta and ilio-femoral arteries derived from pre-procedural computed tomography (CT).
Materials and methods:
We retrospectively reviewed 22...
This review gives an overview of sex-based differences in aortic valve stenosis, spanning from pathophysiological mechanisms and disease progression, clinical presentation, presence of comorbidities, and diagnostic assessment, to treatment and outcomes. In particular, sex-related differences in the degree of aortic valve calcification, the response...
Background:
Transcatheter aortic valve implantation (TAVI) has become a broadly acceptable alternative to AV surgery in patients with aortic stenosis (AS). New valve designs are becoming available to address the shortcomings of their predecessors and improve clinical outcomes.
Methods:
A systematic review and meta-analysis was carried out to com...
Background
“valve‐in‐valve” TAVR (VIV‐TAVR) is established and provides good initial clinical and hemodynamic outcomes. Lacking long‐term durability data baffle the expand to lower risk patients. For those purposes, the present study adds a hemodynamic 3‐years follow‐up.
Methods
A total of 77 patients underwent VIV‐TAVR for failing aortic bioprost...
Purpose
Cerebral infarctions caused by air embolisms (AE) are a feared risk in endovascular procedures; however, the relevance and pathophysiology of these AEs is still largely unclear. The objective of this study was to investigate the impact of the origin (aorta, carotid artery or right atrium) and number of air bubbles on cerebral infarctions in...
Citations
... Therefore a greater focus on early diagnosis, correct management, and prevention of post-procedural complications is key to achieve satisfactory results [4]. ECG-triggered multidetector computed tomography angiography (CTA) is the mainstay imaging modality for pre-procedural planning of TAVI and is also used for post-interventional early detection of both acute and long-term complications [5]. In the clinical routine, valve function is evaluated by means of transthoracic echocardiography (TTE). ...
Transfemoral aortic valve implantation (TAVI) has been long considered the standard of therapy for high-risk patients with severe aortic-stenosis and is now effectively employed in place of surgical aortic valve replacement also in intermediate-risk patients. The potential lasting consequences of minor complications, which might have limited impact on elderly patients, could be more noteworthy in the longer term when occurring in younger individuals. That’s why a greater focus on early diagnosis, correct management, and prevention of post-procedural complications is key to achieve satisfactory results. ECG-triggered multidetector computed tomography angiography (CTA) is the mainstay imaging modality for pre-procedural planning of TAVI and is also used for post-interventional early detection of both acute and long-term complications. CTA allows detailed morphological analysis of the valve and its movement throughout the entire cardiac cycle. Moreover, stent position, coronary artery branches, and integrity of the aortic root can be precisely evaluated. Imaging reliability implies the correct technical setting of the computed tomography scan, knowledge of valve type, normal post-interventional findings, and awareness of classic and life-threatening complications after a TAVI procedure. This educational review discusses the main post-procedural complications of TAVI with a specific imaging focus, trying to clearly describe the technical aspects of CTA Imaging in post-TAVI and its clinical applications and challenges, with a final focus on future perspectives and emerging technologies.
Critical relevance statement
This review undertakes an analysis of the role computed tomography angiography (CTA) plays in the assessment of post-TAVI complications. Highlighting the educational issues related to the topic, empowers radiologists to refine their clinical approach, contributing to enhanced patient care.
Key Points
Prompt recognition of TAVI complications, ranging from value issues to death, is crucial.
Adherence to recommended scanning protocols, and the optimization of tailored protocols, is essential.
CTA is central in the diagnosis of TAVI complications and functions as a gatekeeper to treatment.
Graphical Abstract
... Some studies have shown the usefulness of CT examinations prior to SAVR in order to improve the planning of the surgical intervention. 31,32 The cardiac surgeons involved in the VIVA trial had systematic access to a pre-procedural cardiac CT, with accurate measurements of the aortic annulus in all patients, and this may have positively influenced the Downloaded from http://ahajournals.org by on November 6, 2023 surgical strategy, such as optimized selection of prosthetic valve sizes ideally suited to the patient's annulus. Also, larger valves were implanted in the TAVR group due to the oversizing strategy needed to ensure an appropriate implantation of the transcatheter valves and the absence of residual paravalvular leaks. ...
Background: The optimal treatment in patients with severe aortic stenosis (AS) and small aortic annulus (SAA) remains to be determined. The objectives of this study were to compare the hemodynamic and clinical outcomes between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with a SAA.
Methods: Prospective multicenter international randomized trial performed in 15 university hospitals. Participants were 151 patients with severe AS and SAA (mean diameter <23 mm) were randomized (1:1) to TAVR (n=77) vs SAVR (n=74), The primary outcome was impaired valve hemodynamics (i.e. severe prosthesis patient mismatch [PPM ] or moderate-severe aortic regurgitation [AR]) at 60 days as evaluated by Doppler-echocardiography and analyzed in a central echocardiography core laboratory. Clinical events were secondary outcomes.
Results: The mean age of the participants was 75±5 years, with 140 (93%) women, a median STS of 2.50 (1.67-3.28)%, and a median annulus diameter of 21.1 (IQR: 20.4-22.0) mm. There were no differences between groups in the rate of severe PPM or moderate-severe AR (severe PPM (TAVR: 4 [5.6 %], SAVR: 7 [10.3%], p=0.30), and moderate-severe AR (none in both groups). There were no differences between groups regarding mortality (TAVR: 1 [1.3%], SAVR: 1 [1.4%], p=1.00) and stroke (TAVR:0, SAVR: 2 [2.7%], p=0.24) at 30 days. After a median follow-up of 2 (1-4) years, there were no differences between groups regarding mortality (TAVR: 7 [9.1%], SAVR: 6 [8.1%], p=0.89), stroke (TAVR: 3 [3.9%], SAVR: 3 [4.1%], p=0.95), and cardiac hospitalization (TAVR: 15 [19.5%], SAVR: 15 [ 20.3%], p=0.80).
Conclusions: In patients with severe AS and SAA (women in the vast majority), there was no evidence of superiority of contemporary TAVR vs. SAVR regarding valve hemodynamic results. After a median follow-up of 2 years, there were no differences in clinical outcomes between groups. These findings suggest that the 2 therapies represent a valid alternative for treating patients with SA and SAA, and treatment selection should likely be individualized according to baseline characteristics, additional anatomical risk factors, and patient preference. However, the results of this study should be interpreted with caution due to the limited sample size leading to an underpowered study, and need to be confirmed in future larger studies.
... Some studies have shown the usefulness of CT examinations prior to SAVR in order to improve the planning of the surgical intervention. 29,30 The cardiac surgeons involved in the VIVA trial had systematic access to a pre-procedural cardiac CT, with accurate measurements of the aortic annulus in all patients, and this may have positively influenced the surgical strategy, such as optimized selection of prosthetic valve sizes ideally suited to the patient's annulus. Also, sutureless valves were used in a high proportion of patients, and some studies have shown improved hemodynamic results with this type of surgical valve, particularly in patients with SAA. 31 Although most patients undergoing SAVR had a stented bioprosthesis, the vast majority received a recent valve generation, with superior hemodynamic performance compared to prior valve generations. ...
BACKGROUND
The optimal treatment in patients with severe aortic stenosis (AS) and small aortic annulus (SAA) remains to be determined. The objectives of this study were to compare the hemodynamic and clinical outcomes between transcatheter aortic valve replacement (TAVR) and surgical aortic valve replacement (SAVR) in patients with a SAA.
METHODS
Prospective multicenter international randomized trial performed in 15 university hospitals. Participants were 151 patients with severe AS and SAA (mean diameter <23 mm) were randomized (1:1) to TAVR (n=77) vs SAVR (n=74), The primary outcome was impaired valve hemodynamics (i.e. severe prosthesis patient mismatch [PPM] or moderate-severe aortic regurgitation [AR]) at 60 days as evaluated by Doppler-echocardiography and analyzed in a central echocardiography core laboratory. Clinical events were secondary outcomes.
RESULTS
The mean age of the participants was 75±5 years, with 93 of women, a median STS of 2.5 (1.7-3.3)%, and a mean annulus diameter of 21.1±1.2 mm.
CONCLUSIONS
This trial will provide clinicians with scientific evidence to determine if population with smaller aortic anatomy in the setting of severe AS maybe better suited to TAVR compared with SAVR.
TRIAL REGISTRATION
Clinicaltrials.gov : NCT03383445
