Clinical value of non–electrocardiogram-gated computed tomography angiography for planning transcatheter aortic valve implantation: A retrospective single-centre study

Purpose Computed tomography angiography (CTA) is a key component of preprocedural planning for transcatheter aortic valve implantation (TAVI). Although current guidelines recommend electrocardiogram (ECG)-gated acquisition of the aortic root, non–ECG-gated CTA protocols are still used in clinical practice. The present study aimed to evaluate the clinical feasibility and safety of a non–ECG-gated CTA protocol for TAVI planning. Methods We conducted a retrospective, single-centre observational study including 194 consecutive patients who underwent TAVI between January 2012 and December 2024 and were planned using a non–ECG-gated, single-phase CTA protocol . CTA-derived anatomical measurements were used to guide prosthesis selection and vascular access planning. Clinical outcomes were assessed during the index hospitalization and up to 30 days. Results CTA measurements were successfully used to guide prosthesis sizing in all patients. Thirty-day all-cause mortality was 3.6%, stroke or transient ischaemic attack occurred in 1.5% of patients, and vascular complications were observed in 6.7%. Conduction disturbances occurred in 38.1% of patients, while new permanent pacemaker implantation was required in 3.1%. Paravalvular leak (PVL) was predominantly mild; no cases of severe PVL were observed, and no patient required surgical or interventional correction for PVL. Conclusion This study demonstrates that a non–ECG-gated CTA protocol appears feasible and may support TAVI planning in selected centres with experienced teams. In this single-centre experience, a non–ECG-gated CTA protocol provided sufficient anatomical information for TAVI planning, with acceptable short-term clinical outcomes. While ECG-gated CTA remains the reference standard, this approach may represent a pragmatic alternative when integrated into a structured workflow.