From the Guidelines
The workup for Transcatheter Aortic Valve Replacement (TAVR) involves a multidisciplinary approach, including assessment of the aortic annulus and aortic root, as well as evaluation of supravalvular aorta and vascular access.
- The assessment of the aortic annulus and aortic root is crucial for guiding the choice of valve prosthesis and determining the optimal device size 1.
- Evaluation of supravalvular aorta and vascular access is necessary for determining the vascular access site and road mapping the desired device delivery 1.
- The workup should also include a comprehensive evaluation of the patient's clinical status, including assessment of left ventricular function, pulmonary hypertension, and other comorbidities 1.
- Imaging modalities such as echocardiography and computed tomography (CT) play a critical role in the workup for TAVR, providing valuable information on the anatomy of the aortic valve and surrounding structures 1.
- A multidisciplinary team (MDT) approach is essential for patient selection and evaluation, involving cardiologists, cardiothoracic surgeons, and other specialists to ensure that patients are properly evaluated and treated 1.
- The MDT should discuss the risks and benefits of TAVR with the patient, as well as the available treatment options, including surgical aortic valve replacement (SAVR) 1.
From the Research
Preoperative Planning for TAVR
The workup for Transcatheter Aortic Valve Replacement (TAVR) involves several key steps, including:
- Patient selection: identifying suitable candidates for TAVR, taking into account factors such as severe aortic stenosis, high surgical risk, and intermediate risk 2, 3
- Imaging: using multi-detector computed angiotomography (MDCT) as the gold standard for preoperative planning, with 3D echocardiography and magnet resonance imaging (MRI) as alternative options for some patients 2
- Vascular access planning: selecting the most suitable access site, such as transfemoral (TF), trans-aortic, trans-apical, trans-caval, trans-carotid, or trans-axillary (TAx), based on patient anatomy and disease characteristics 4, 5
- Risk assessment: evaluating the patient's risk profile, including functional and frailty evaluation, to determine the best approach for TAVR 3
Imaging and Procedural Techniques
The workup for TAVR also involves:
- Aortic valve annulus measurements: using imaging techniques such as MDCT to determine the size and anatomy of the aortic valve annulus 2
- Transcatheter heart valve choice: selecting the most suitable valve type and size based on patient anatomy and disease characteristics 2
- Procedural complication anticipation: identifying potential complications and developing strategies to mitigate them 5, 2
Access Planning and Strategies
The choice of access site for TAVR depends on various factors, including:
- Patient anatomy: selecting the most suitable access site based on patient anatomy, such as iliofemoral artery diameter and disease characteristics 4, 5
- Disease characteristics: considering the severity of aortic stenosis and other comorbidities when selecting the access site 4, 5
- Operator experience: choosing an access site that is familiar to the operator and the TAVR team 4, 5