Multidetector computed tomography in transcatheter aortic valve replacement: an update on technological developments and clinical applications

ABSTRACT

Introduction

Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients with underlying sever aortic valve stenosis across all spectrum of the disease. CT imaging is so crucial to the pre procedural planning, to incorporate the information from the CT imaging in the decision making intraprocedurally and to predict and identity the post procedural complications.Areas covered: In this article, we review available studies on CT role in TAVR procedure and provide update on the technological developments and clinical applications.Expert opinion: CT imaging, with its high resolution, and in particular its utilization in aortic annular measurements, bicuspid aortic valve assessment, hypoattenuated leaflet thickening and valve in valve therapy proved to be the ideal approach to study the mechanisms of aortic stenosis, detection of high-risk anatomy, more accurate risk stratification and thus to allow a personalized catheter based intervention of the affected patients.

KEYWORDS:

• CT scan
• TAVR
• bicuspid
• valve in valve
• 3D printing

Article highlights

• Cardiac CT is a vital tool in assessing the patients undergoing transcatheter aortic valve implantation.

• Cardiac CT is the gold-standard test for assessing the morphology of the aortic valve, annular sizing and the vascular access.

• Pre TAVR three dimensional cardiac CT scan has been proposed to predict the paravalvular regurgitation as well as coronary obstruction.

• Post TAVR CT applications include the identification of subclinical leaflet thrombosis, estimating the risk of coronary occlusion in valve in valve TAVR and determining the unfavorable coronary access post TAVR.

• Cardiac CT seems to have a potential role in the risk stratification using the minimalist approach in the TVAR field.

Declaration of interest

The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or materials discussed in the manuscript.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Additional information

Funding

This paper was not funded.