Advanced multimodality imaging enhances procedural safety and improves clinical outcomes in transcatheter cardiac surgery by enabling precise anatomical characterization and early complication detection.
Multimodality imaging is the cornerstone for lifetime management strategies in transcatheter cardiac surgery, guiding patient selection, procedural planning, and complication prediction.
Transcatheter cardiac surgery (TCS), which primarily comprises transcatheter aortic valve replacement (TAVR) and mitral transcatheter edge-to-edge repair (M-TEER), has transformed the treatment of valvular heart disease over the past two decades. Moreover, TAVR is now supported by robust randomized trial evidence across the surgical risk spectrum, establishing this technique as a cornerstone therapy for aortic stenosis. Moreover, M-TEER is gaining clinical relevance, with expanding registry and trial data further defining the role of this technique. Meanwhile, advanced imaging has become central to both TAVR and M-TEER, extending beyond diagnosis to patient selection, procedural planning, and risk assessment of complications. Furthermore, advanced imaging enhances procedural safety and improves short- and mid-term clinical outcomes by enabling accurate anatomical characterization, precise device sizing, and early detection of complications such as paravalvular leak or leaflet thrombosis. Echocardiography and computed tomography form the backbone of the preprocedural evaluations, whereas cardiac magnetic resonance and positron emission tomography provide complementary insights into myocardial pathology and prosthetic valve dysfunction. Imaging enables structured surveillance for paravalvular leak, leaflet thrombosis, recurrent regurgitation, and structural valve degeneration, all of which directly affect outcomes. However, despite considerable progress, important challenges persist, including limited evidence on the long-term durability of TAVR, a lack of standardized grading of residual mitral regurgitation after M-TEER, and the need to integrate right heart–pulmonary circulation assessments into decision-making. Recent innovations such as quantitative three-dimensional echocardiography, fusion imaging, and artificial-intelligence-based image analysis are expected to refine procedural planning further, reduce operator variability, and enable more predictive, patient-specific management. Nonetheless, multimodality imaging is slated to remain the cornerstone for lifetime management strategies in TCS.
Keita Shibata (Mon,) conducted a review in Valvular heart disease (Aortic stenosis and Mitral regurgitation). Advanced multimodality imaging in transcatheter cardiac surgery (TAVR and M-TEER) was evaluated. Advanced multimodality imaging enhances procedural safety and improves clinical outcomes in transcatheter cardiac surgery by enabling precise anatomical characterization and early complication detection.