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Managing Complex Anatomical Scenarios in Tavi: Evidence and an Institutional Perspective.
Orlando Piro1, Mattia Granato1, Simona Covino1
1Division of Cardiology, Monaldi Hospital, 80131 Naples, Italy.
Journal of Clinical Medicine
|November 13, 2025
Summary
Transcatheter aortic valve implantation (TAVI) in complex anatomy requires careful imaging and technique. This approach details managing challenging scenarios like bicuspid aortic valves and calcification for improved safety and outcomes.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Imaging
Background:
- Transcatheter aortic valve implantation (TAVI) is standard for severe aortic stenosis in elderly patients.
- Outcomes in complex anatomies are challenging and depend on precise imaging and technique.
Purpose of the Study:
- To present an institutional approach for managing challenging anatomical scenarios during TAVI.
- To provide practical strategies for minimizing complications in high-impact cases.
Main Methods:
- Review of current literature and institutional experience.
- Focus on seven high-impact anatomical scenarios: bicuspid aortic valve (BAV), difficult access, tortuosity, aortic angulation, calcification, small annulus, and coronary obstruction risk.
- Utilizing pre-procedural Computed Tomography (CT) for accurate sizing and planning.
Main Results:
- Current transcatheter heart valves (THV) show favorable outcomes in BAV with tailored sizing and implantation depth.
- Adjunctive vascular interventions are sometimes needed for THV delivery.
- CT-driven planning standardizes decision-making and improves safety in complex cases.
Conclusions:
- A structured, CT-guided pathway is crucial for managing complex TAVI anatomies.
- Specialized Valve Centers with expert operators are essential for high-volume, complex cases and managing complications.
Keywords:
aortic tortuosity and angulationbicuspid aortic valve (BAV)complex aortic anatomyhostile transfemoral accesstranscatheter aortic valve implantation (TAVI)More Related Videos
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