Can TAVR Be Effectively and Safely Performed Without Intraprocedural TEE?

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Transcatheter aortic valve replacement (TAVR) is a primary treatment for severe aortic stenosis.
• Minimalist TAVR strategies aim to reduce invasiveness and hospital stays.
• Transesophageal echocardiography (TEE) has traditionally been used but may be less relevant in streamlined TAVR.

Purpose of the Study:

• To review the safety and efficacy of performing TAVR without intraprocedural TEE.
• To update current understanding of TEE's role in modern TAVR procedures.

Main Methods:

• Review of existing studies and clinical data on TAVR procedures.
• Comparison of outcomes between TAVR with and without intraprocedural TEE.
• Analysis of imaging modalities used in TAVR, including transthoracic echocardiography (TTE) and fluoroscopy.

Main Results:

• TAVR performed under local anesthesia without TEE is as safe as TEE-guided procedures.
• Transthoracic echocardiography and fluoroscopy are sufficient primary imaging tools for most TAVR cases.
• While TEE is less crucial, it can still be beneficial in complex cases or when TTE windows are inadequate.

Conclusions:

• Intraprocedural TEE is not essential for the majority of TAVR procedures.
• Minimalist TAVR approaches without TEE are safe and effective.
• TEE remains a valuable tool for specific complex scenarios and challenging TAVR cases.