From the Guidelines
Pre-procedure evaluation for TAVR should include a comprehensive assessment of the aortic annulus and aortic root, as well as the supravalvular aorta and vascular access, using imaging modalities such as US echocardiography, MRI, or CT with IV contrast, as recommended by the most recent guidelines 1. The key components of the pre-procedure evaluation for TAVR include:
- Cardiac evaluation:
- Echocardiography (transthoracic and transesophageal) to assess the aortic valve and cardiac function
- Cardiac catheterization to evaluate coronary artery disease and cardiac function
- CT angiography of the heart and aorta to assess the aortic annulus and root
- Anatomical assessment:
- CT scan of chest, abdomen, and pelvis to evaluate the supravalvular aorta and vascular access
- Evaluation of peripheral vasculature to determine the best access site for the procedure According to the most recent guidelines, US echocardiography, MRI, or CT with IV contrast are usually appropriate for the initial imaging assessment of the aortic root and supravalvular aorta in patients undergoing preintervention planning for TAVR 1. The pre-procedure evaluation should also include a general health assessment, specialty consultations, and medication review and adjustment to optimize the patient's condition and minimize potential risks.
- General health assessment:
- Complete blood count
- Metabolic panel
- Coagulation studies
- Chest X-ray
- Pulmonary function tests
- Specialty consultations:
- Cardiology
- Cardiac surgery
- Anesthesiology
- Medication review and adjustment:
- Anticoagulation management
- Antibiotic prophylaxis This comprehensive evaluation helps determine the patient's eligibility for TAVR, assess potential risks, and plan the most appropriate approach for the procedure, ultimately improving morbidity, mortality, and quality of life outcomes 1.
From the Research
Pre-Procedure Evaluation for TAVR
The pre-procedure evaluation for Transcatheter Aortic Valve Replacement (TAVR) is a crucial step in ensuring the success of the procedure. The evaluation process involves several steps, including:
- Patient selection: The Heart Team plays a significant role in evaluating patients for TAVR, and their assessment may deem patients to be at higher risk than their formal scores suggest 2.
- Procedural planning: Multislice computed tomography (MSCT) is a fundamental component of preprocedural planning, helping to establish procedural feasibility, determine the type of vascular approach, and select the most suitable device 3.
- Imaging technologies: Various imaging technologies, such as echocardiography, cardiac catheterization, cardiac computed tomography, and cardiac magnetic resonance, are used to assess the anatomy, physiology, and pathophysiology of the aortic valvular complex, ventricular function, and peripheral vasculature 4.
- Coronary artery disease evaluation: The evaluation of coronary artery disease (CAD) is an essential part of the pre-TAVR workup, and invasive coronary angiography and percutaneous coronary interventions (PCI) may be performed as part of the evaluation process 5.
Key Considerations
Some key considerations in the pre-procedure evaluation for TAVR include:
- The importance of a comprehensive evaluation by the Heart Team to determine the patient's risk profile 2.
- The use of MSCT to plan and guide the TAVR procedure 3.
- The role of imaging technologies in assessing the patient's anatomy, physiology, and pathophysiology 4.
- The evaluation of CAD and the potential need for PCI or other interventions 5.
Imaging Technologies
The following imaging technologies are commonly used in the pre-procedure evaluation for TAVR:
- Echocardiography: Used to assess the aortic valvular complex and ventricular function 4.
- Cardiac catheterization: Used to assess the coronary arteries and evaluate CAD 5.
- Cardiac computed tomography: Used to assess the anatomy of the aortic valvular complex and peripheral vasculature 3, 4.
- Cardiac magnetic resonance: Used to assess the physiology and pathophysiology of the aortic valvular complex and ventricular function 4.