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September 2, 2026Journal of Cardiovascular ImagingOpen Access

Intraprocedural TEE remains essential in complex TAVI to optimize outcomes and minimize complications.

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Why the study?

Despite a shift toward minimalist TAVI approaches under local anesthesia, intraprocedural echocardiographic imaging remains valuable for real-time guidance, complication assessment, and procedural evaluation.

Population

Patients with severe aortic stenosis undergoing TAVI

Comparison

TTE vs TEE (including mini- or micro-TEE) vs ICE guidance

Design

Review

Key result

Intraprocedural transesophageal echocardiography remains indispensable in complex transcatheter aortic valve implantation cases to optimize outcomes and minimize complications.

Authors

TCTai Meng ChenMAMohammed Rizwan AmanullahSESee Hooi Ewe

Discussion

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Overview

Supports selective TEE in complex TAVI amid minimalist trends; leaves open prospective trials of imaging strategies.

Key Points

  • To review the utility, advantages, and limitations of various intraprocedural echocardiographic modalities in transcatheter aortic valve implantation (TAVI) and propose individualized imaging strategies.
  • Evaluated the performance and clinical utility of transthoracic echocardiography (TTE), transesophageal echocardiography (TEE; adult-, mini-, and micro-TEE), and intracardiac echocardiography (ICE) during TAVI.
  • Assessed imaging workflows across procedural settings ranging from minimalist conscious sedation protocols to complex, high-risk anatomical scenarios.
  • TTE supports minimalist conscious sedation workflows but carries risks of suboptimal image quality, leading to potential underestimation of paravalvular leak and missed complications.
  • TEE provides superior spatial resolution and real-time 3D annular sizing, with mini-TEE serving as an optimal modality that is well tolerated under local anesthesia and conscious sedation.
  • ICE enables high-resolution real-time imaging by the primary operator without general anesthesia, offering a viable alternative for patients with poor acoustic windows or TEE contraindications.

Structured PICO

P
Population
Patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI)
I
Intervention
Intraprocedural echocardiographic guidance (TTE, TEE, or ICE)

While minimalist approaches to TAVI are feasible, intraprocedural TEE remains indispensable in complex cases to optimize outcomes and minimize complications.

Limitations

  • TTE image quality may be suboptimal, leading to missing complications and underestimation of paravalvular leak.
  • ICE is costly with single use and requires additional venous access.

Cite This Study

Chen et al. (2026) conducted a review in severe aortic stenosis. Intraprocedural echocardiographic guidance was evaluated. Intraprocedural transesophageal echocardiography remains indispensable in complex transcatheter aortic valve implantation cases to optimize outcomes and minimize complications.

synapsesocial.com/papers/6a98131ec562ede874ec7c32https://doi.org/10.1186/s44348-026-00094-5
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