Transcatheter aortic valve implantation: implications of multimodality imaging in patient selection, procedural guidance, and outcomes
- Victoria Delgado1,
- Samir Kapadia2,
- Martin J Schalij1,
- Joanne D Schuijf1,
- E Murat Tuzcu2,
- Jeroen J Bax1
- 1Department of Cardiology, Leiden University Medical Center, Leiden, The Netherlands
- 2Department of Cardiovascular Medicine, Cleveland Clinic Foundation, Cleveland, Ohio, USA
- Correspondence to Dr Victoria Delgado, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2, 2333 ZA Leiden, the Netherlands; v.delgado{at}lumc.nl
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Contributors All the authors have actively participated in the conception and design of the review, drafting the article and revising it critically for important intellectual content, and have given final approval of the version to be published.
- Transcatheter aortic valve implantation
- echocardiography
- multidetector row CT
- MRI
- echocardiography
- mitral valve
- aorta
- great vessels and trauma
- arrhythmias
- cardiac function
Degenerative aortic stenosis is the most prevalent aortic valve disease in western countries. Ageing processes and increased life expectancy of the population increase the prevalence of this valvular heart disease.w1 Surgical aortic valve replacement is the first therapeutic option for patients with severe symptomatic aortic stenosis. However, in selected subgroups of patients, the operative risk may outweigh the clinical benefits of surgery. Older age, severe left ventricular systolic dysfunction, and associated comorbidities such as neurological diseases are the main determinants of non-referral for surgery in almost 30% of patients with severe symptomatic aortic stenosis.w2
Technological advances in the field of percutaneous cardiovascular interventions have favoured the development of less invasive therapeutic strategies. The emerging transcatheter aortic valve implantation (TAVI) techniques have been shown to be a feasible alternative to surgical aortic valve replacement.w3 To date, >40 000 patients have been treated worldwide with the use of two different devices: the self-expandable prosthesis (Medtronic CoreValve, Medtronic, Minneapolis, Minnesota, USA), and the balloon expandable prosthesis (Edwards-SAPIEN, Edwards Lifesciences, Irvine, California, USA).w4 The reported procedural success rates range between 94–98% with acceptable procedure related complication rates (5–18%), bearing in mind the high operative risk of the patients.w3 Despite these encouraging results, several safety issues are still a source of debate. Vascular complications, stroke incidence and prevalence, and the long term consequences of post-procedural aortic regurgitation are the main concerns of this novel therapy.
Accurate preprocedural evaluation of patients who are candidates for TAVI is mandatory to plan the most adequate therapeutic approach and to select the prosthesis size. The role of the …
