ACR Appropriateness Criteria® Preprocedural Planning for Transcatheter Aortic Valve Replacement: 2023 Update

Area of Science:

• Cardiology
• Radiology
• Medical Imaging

Background:

• Transcatheter aortic valve replacement (TAVR) requires meticulous preprocedural planning.
• Appropriate imaging is crucial for assessing cardiac structures and vascular access before TAVR.
• The American College of Radiology Appropriateness Criteria provide evidence-based guidelines for medical imaging.

Purpose of the Study:

• To evaluate imaging modalities for preprocedural planning in TAVR.
• To assess the appropriateness of imaging for the aortic root.
• To assess the appropriateness of imaging for the supravalvular aorta and vascular access.

Main Methods:

• Review of imaging modalities including echocardiography, MRI, and CT for aortic root assessment.
• Review of CTA protocols for supravalvular aorta and vascular access assessment.
• Application of the RAND/UCLA Appropriateness Method and GRADE principles for evidence evaluation.

Main Results:

• Echocardiography, MRI, and CT are usually appropriate for aortic root assessment.
• CTA of the chest, abdomen, and pelvis are usually appropriate for supravalvular aorta and vascular access assessment.
• Guidelines are based on systematic literature analysis and expert consensus when evidence is limited.

Conclusions:

• Specific imaging modalities are recommended for different aspects of TAVR preprocedural planning.
• Adherence to established appropriateness criteria ensures optimal patient selection and procedural success.
• These evidence-based guidelines support standardized and effective TAVR planning.