The Role of Preprocedural CT in Redo Transcatheter Aortic Valve Replacement: A Radiologist's Perspective

Area of Science:

• Cardiovascular Imaging
• Interventional Cardiology

Background:

• Transcatheter aortic valve replacement (TAVR) is increasingly used in younger patients who may outlive the durability of their initial transcatheter heart valve (THV).
• THV failure necessitates re-intervention, often via redo TAVR (TAV-in-TAV).

Purpose of the Study:

• To outline the specific cardiac CT assessment required for preprocedural redo TAVR.
• To highlight differences in CT evaluation compared to initial TAVR or TAVR of surgical valves.

Main Methods:

• Cardiac CT is utilized to assess the mechanism of THV failure (structural vs. nonstructural dysfunction).
• CT guides the sizing and selection of the new THV for redo TAVR.
• Evaluation includes assessment of the index THV characteristics and alignment for commissural and coronary access.

Main Results:

• Cardiac CT is essential for differentiating THV dysfunction mechanisms.
• CT findings inform the choice of THV type and size for redo TAVR.
• CT assessment identifies risks such as coronary obstruction and future coronary access issues.

Conclusions:

• Cardiac CT is a vital tool for evaluating failed THVs and planning redo TAVR.
• Specific CT assessments are needed for TAV-in-TAV procedures to optimize outcomes and safety.