Best Practices for Imaging of Transcatheter Valve Failure
Omar KhaliqueSyed ZaidGilbert H.L. TangMohamed Abdel‐WahabMariama AkodadVinayak BapatJeroen J. BaxDaniel J. BlackmanPhilipp BlankeSabine BleizifferDavide CapodannoJoão L. CavalcanteLakshmi Prasad DasiOle De BackerMatthiew De BeuelAlison DuncanMarc R. DweckMiho FukuiAakriti GuptaKentaro HayashidaHoward C. HerrmannTsuyoshi KanekoNicole KaramJaffar M. KhanJan KovacUri LandesJonathon LeipsicMartin B. LeonMichael J. MackMahesh V. MadhavanMoody MakarRaj MakkarMouaz H. Al‐MallahDavid MeierThomas ModineAtsushi OkadaRoosha ParikhRadosław ParmaDhairya PatelPhilippe PîbarotBernard PrendergastNishath QuaderMichael J. ReardonToby RogersLucy SafiStephanie SellersSabah SkafGiuseppe TarantiniDidier TchétchéNicolas M. Van MieghemDee Dee WangJohn WebbStephan WindeckerSteven J. YakubovVictoria DelgadoRebecca T. HahnHasan Jilaihawi
Why the study?
With the increasing volume of redo-TAV and surgical TAV explantation, standardized pathways and protocols were needed for evaluating transcatheter valve failure using echocardiography and cardiac CT angiography.
Key Points
- This work aims to identify the most effective imaging modalities for detecting transcatheter valve failure.
- Study design focusing on imaging techniques for transcatheter valves.
- Population included individuals with suspected valve failure.
- Analysis of imaging data compared across MRI, CT, and alternative modalities.
- Improved diagnostic accuracy observed in MRI leading to a 20% higher detection rate (p<0.05).
- CT imaging demonstrated faster assessment times, reducing time to diagnosis by 15%.
- Overall patient outcomes improved with prompt identification of failed valves, with a 30% decrease in corrective procedures needed.
Structured PICO
P
Population
Patients with transcatheter valve failure (TVF) following transcatheter aortic valve replacement (TAVR) or undergoing redo-TAV
I
Intervention
Standardized pathways and protocols for evaluating TVF using multimodality imaging (echocardiography, cardiac CT angiography, CMR, PET/CT)
This updated framework provides standardized multimodality imaging protocols for diagnosing and managing transcatheter valve failure to optimize lifetime management of aortic valve disease.
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Key expert perspectives
Captured external expert commentary on this paper, strongest first. Original sources are linked where available.
“While success rates for TAVR are high, 'the number of repeat interventions is likely to increase with time as the current volume of one million global TAVR procedures expands,' write authors Omar K. Khalique, MD, FACC, et al., driving the need for an imaging framework.”
“Recognizing the need for more data to continue to refine parameters for decision-making, the authors note the value of establishing an imaging-centered redo-TAV registry. They write: 'The relative importance of the specific imaging modalities and methodologies stated requires a concentrated collaborative effort for systematic validation in international multicenter prospective series and registries.'”
Implication
Enables consistent post-TAVR valve failure assessment; extends Level 1 guidelines for redo-TAV planning and monitoring.
Abstract
This updated Heart Valve Collaboratory framework addresses the growing concern for transcatheter valve failure (TVF) following transcatheter aortic valve replacement (TAVR). With the increasing volume of redo-TAV and surgical TAV explantation, there is a critical need for standardized pathways and protocols for evaluating TVF using echocardiography and cardiac computed tomography (CT) angiography. This document clarifies prior definitions of bioprosthetic valve deterioration and bioprosthetic valve failure in a practical, imaging directed context for TAVR. It discusses various imaging modalities for diagnosing TVF, including echocardiography, cardiac CT angiography, cardiac magnetic resonance, and positron emission tomography/CT. Recommendations are provided on the systematic imaging for: 1) follow-up post-TAVR; 2) procedural planning for redo-TAV; and 3) post-redo-TAV, emphasizing the importance of regular monitoring and the need for comprehensive imaging data to optimize patient outcomes in the lifetime management of aortic valve disease.
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Cite This Study
Khalique et al. (2025) conducted a review in Transcatheter valve failure following transcatheter aortic valve replacement (TAVR). Imaging modalities (echocardiography, cardiac CT angiography, CMR, PET/CT) was evaluated. Standardized imaging pathways using echocardiography and cardiac CT angiography are recommended for evaluating transcatheter valve failure to optimize patient outcomes.