Recommendations for comprehensive intraprocedural echocardiographic imaging during TAVR

Area of Science:

• Cardiology
• Medical Imaging
• Interventional Cardiology

Background:

• Transcatheter aortic valve replacement (TAVR) is increasingly utilized for severe symptomatic aortic stenosis in high-risk patients.
• Established surgical options exist, but TAVR offers a less invasive alternative.
• Multicenter trials validate TAVR's efficacy in this patient cohort.

Purpose of the Study:

• To provide comprehensive recommendations for imaging in TAVR.
• To guide pre-procedural and intra-procedural imaging protocols.
• To standardize assessment for both balloon-expandable and self-expanding TAVR systems.

Main Methods:

• Review of current imaging modalities for TAVR assessment.
• Echocardiography and multislice computed tomography (MSCT) for pre-procedural evaluation.
• Transesophageal echocardiography (TEE) for intra-procedural guidance and post-procedural assessment.

Main Results:

• Echocardiography and MSCT are crucial for pre-procedural imaging of the aortic valve complex and vascular access.
• TEE is valuable for intra-procedural confirmation of landing zone, measurements, and valve positioning.
• TEE aids in the post-procedural evaluation of potential complications.

Conclusions:

• Standardized imaging protocols are essential for successful TAVR outcomes.
• Accurate pre-procedural and intra-procedural imaging optimizes patient selection and procedural success.
• Imaging plays a critical role throughout the TAVR process, from planning to complication assessment.