Key result
Both 3D transesophageal echocardiography and multi-detector computed tomography perform similarly in aortic annulus sizing and remain essential for pre-procedural planning in transcatheter aortic valve replacement.
Both 3D TEE and MDCT play pivotal and complementary roles in the pre-procedural planning and peri-procedural guidance of TAVR.
Supports flexible TAVR planning with either modality; leaves open subgroup-specific optimization.
PURPOSE OF REVIEW: Transcatheter aortic valve replacement (TAVR) is underpinned by an array of imaging techniques designed to not only select an appropriately sized implant but also to identify potential obstacles to procedural success. This review presents currently important aspects of TAVR imaging, describing the salient features of each modality as well as recent developments in the field. RECENT FINDINGS: The latest data on TAVR outcomes reflects the increasing experience of operators and the significant role of pre-procedural imaging. Debate continues as to which modality sizes the aortic annulus most accurately, 3D transoesophageal echocardiography (TEE) or MDCT, as well as to whether the merits of real-time peri-procedural 3D imaging guidance outweigh the possible adverse consequences of general anaesthesia which is requisite for intraprocedural 3D TEE. TAVR is now largely based on pre-acquired roadmaps of the truncal vasculature and intense pre-procedural planning. TEE and Multi-detector computed tomography (MDCT) have been shown to perform similarly in annulus sizing. However, given the complexity of many TAVR patients and the importance of identifying the most suitable pathway to the valve as well as any potentially confounding other structural or functional heart disease, both modalities remain relevant in current TAVR.
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Bleakley et al. (2018) conducted a review in Severe aortic stenosis undergoing TAVR. Pre-procedural imaging (TEE and MDCT) was evaluated. Both 3D transesophageal echocardiography and multi-detector computed tomography perform similarly in aortic annulus sizing and remain essential for pre-procedural planning in transcatheter aortic valve replacement.
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