From the Guidelines
A Transcatheter Aortic Valve Replacement (TAVR) workup includes comprehensive cardiac and vascular imaging, laboratory tests, and clinical assessments to determine patient eligibility and optimize procedural planning, with a focus on assessing the aortic annulus and aortic root, as well as supravalvular aorta and vascular access, as outlined in the 2023 update of the ACR Appropriateness Criteria for preprocedural planning for TAVR 1. The standard workup consists of:
- Transthoracic echocardiography (TTE) to confirm aortic stenosis severity and assess ventricular function
- Transesophageal echocardiography (TEE) for detailed valve anatomy evaluation
- CT angiography of the chest, abdomen, and pelvis to measure the aortic annulus dimensions, evaluate access routes, and determine optimal valve size and deployment angles, as recommended by the 2017 ACC Expert Consensus Decision Pathway for TAVR 1
- Cardiac catheterization to assess coronary artery disease and hemodynamics
- Carotid ultrasound to screen for cerebrovascular disease
- Laboratory tests, including complete blood count, comprehensive metabolic panel, coagulation studies, and biomarkers like BNP
- A 12-lead ECG and pulmonary function tests to identify arrhythmias and assess respiratory status
- Dental evaluation to minimize infection risk
- Frailty assessment to predict post-procedure recovery This comprehensive workup is essential because TAVR outcomes depend on precise anatomical measurements for valve sizing, identification of suitable vascular access, and assessment of procedural risks specific to each patient's anatomy and comorbidities. Key measurements for TAVR planning include:
- Aortic annulus dimensions, such as major and minor diameter, perimeter, and area
- Aortic root measurements, including sinus of Valsalva height and diameter
- Coronary artery height and evaluation of coronary artery and bypass graft stenosis
- Vascular access planning, including measurements of the aorta, iliac arteries, and femoral arteries, as well as evaluation of calcification and tortuosity.
From the Research
TAVR Workup Components
The workup for Transcatheter Aortic Valve Replacement (TAVR) includes several key components, such as:
- Echocardiographic assessment, including 2D/3D transthoracic and/or transoesophageal echocardiography, to evaluate annulus measurements, cardiac function, and concomitant valve diseases 2
- Imaging guidance, such as fusion imaging, which combines transoesophageal echocardiography and fluoroscopy, to assess prosthetic function, position, and hemodynamic implications 2
- Patient selection, including evaluation of symptoms, aortic stenosis severity, and surgical risk 3
- Prosthesis sizing and selection, using echocardiography and other imaging modalities to ensure proper fit and function 3
- Periprocedural guidance, including intracardiac echocardiography, to monitor valve positioning and deployment 4
- Post-procedural follow-up, to evaluate prosthesis performance and detect potential complications, such as paravalvular aortic regurgitation 3
Imaging Modalities
Various imaging modalities are used in the TAVR workup, including:
- Transesophageal echocardiography (TEE) 4
- Intracardiac echocardiography (ICE) 4
- Computed tomography (CT) angiography, to evaluate aortic valve anatomy and iliofemoral access 5
- Fluoroscopy, to guide valve deployment and positioning 2
Considerations for Low-Risk Patients
For low-risk patients, additional considerations include: