From the Guidelines
The pre-operative workup for Transcatheter Aortic Valve Replacement (TAVR) should include a comprehensive evaluation with cardiac imaging, such as US echocardiography, MRI, or CT, to assess the aortic root and supravalvular aorta, as well as vascular access assessment with CTA chest, abdomen, and pelvis with IV contrast, as recommended by the most recent guidelines 1.
Key Components of Pre-Op Workup
- Cardiac imaging: US echocardiography transesophageal, or MRI heart function and morphology without and with IV contrast, or MRI heart function and morphology without IV contrast, or CT heart function and morphology with IV contrast to assess the aortic root 2
- Vascular access assessment: CTA chest with IV contrast, or CTA abdomen and pelvis with IV contrast, or CTA chest abdomen pelvis with IV contrast to evaluate the supravalvular aorta and vascular access 2
- Clinical assessment: medical history, physical examination, and evaluation of symptoms
- Laboratory work: complete blood count, comprehensive metabolic panel, coagulation studies, and urinalysis
- Dental evaluation: to identify and treat potential sources of infection ### Importance of Heart Team Review The Heart Team, consisting of interventional cardiologists, cardiac surgeons, imaging specialists, and anesthesiologists, should review all data to determine TAVR suitability and develop a procedural plan, as recommended by the American College of Cardiology 3, 4.
Recent Guidelines
The most recent guidelines from the American College of Radiology 1 and the American College of Cardiology 3, 4 emphasize the importance of a comprehensive pre-operative workup for TAVR, including cardiac imaging and vascular access assessment, to optimize patient outcomes and minimize complications.
From the Research
Pre-Operative Workup for TAVR
The pre-operative workup for Transcatheter Aortic Valve Replacement (TAVR) is a crucial step in ensuring the success of the procedure. The following are the key components of the pre-operative workup:
- Clinical assessment: This includes evaluating the patient's overall health, medical history, and risk factors for the procedure 5.
- Surgical and frailty risk scoring: This helps to determine the patient's suitability for the procedure and the potential risks involved 6, 5.
- Blood investigations: These are necessary to evaluate the patient's blood chemistry and identify any potential issues that may affect the procedure 6.
- Echocardiography: This is used to evaluate the patient's heart function, valve anatomy, and other cardiac structures 7, 8.
- Pulmonary function tests: These are used to evaluate the patient's lung function and identify any potential issues that may affect the procedure 6.
- Computed tomography (CT) angiography: This is used to evaluate the patient's aortic valve anatomy, iliofemoral arteries, and other cardiac structures 9, 6, 8.
- Cardiac catheterization: This is used to evaluate the patient's coronary arteries and other cardiac structures 6, 8.
- Magnetic resonance imaging (MRI): This is used as an alternative to CT angiography in some patients 9.
- Iliofemoral angiography: This is used to evaluate the patient's iliofemoral arteries and determine the suitability of the transfemoral approach 6.
- Aortography: This is used to evaluate the patient's aortic valve anatomy and other cardiac structures 6.
- Haemodynamic evaluation: This is used to evaluate the patient's cardiac function and identify any potential issues that may affect the procedure 6.
- Coronary angiography: This is used to evaluate the patient's coronary arteries and identify any potential issues that may affect the procedure 6.
- Right heart catheterization: This is used to evaluate the patient's right heart function and identify any potential issues that may affect the procedure 6.
Imaging Modalities
The choice of imaging modality depends on the patient's individual needs and the availability of equipment. The following imaging modalities are commonly used in the pre-operative workup for TAVR:
- Multi-detector computed angiotomography (MDCT): This is the gold standard for pre-operative planning and provides detailed information about the patient's aortic valve anatomy and other cardiac structures 9.
- 3D echocardiography: This is used to evaluate the patient's heart function, valve anatomy, and other cardiac structures 7, 8.
- Magnet resonance imaging (MRI): This is used as an alternative to CT angiography in some patients 9.
- Cardiac computed tomography: This is used to evaluate the patient's aortic valve anatomy, iliofemoral arteries, and other cardiac structures 8.
- Cardiac magnetic resonance: This is used to evaluate the patient's cardiac function, valve anatomy, and other cardiac structures 8.