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 across all surgical risk levels.
• Patients receiving TAVR at younger ages may outlive the durability of their initial transcatheter heart valve (THV).
• THV failure necessitates reintervention, often via redo TAVR (TAV-in-TAV).

Purpose of the Study:

• To highlight the distinct role of cardiac CT in evaluating index THV failure.
• To guide the selection of the new THV type and size for redo TAVR procedures.
• To emphasize the importance of assessing commissural and coronary alignment for redo TAVR.

Main Methods:

• Cardiac CT is utilized to assess the mechanism of THV failure, differentiating between structural and nonstructural dysfunction.
• CT imaging guides the sizing and selection of the new THV for redo TAVR.
• Preprocedural CT assessment for redo TAVR considers index THV characteristics and alignment from the initial procedure.

Main Results:

• Cardiac CT effectively identifies THV dysfunction mechanisms.
• CT imaging informs optimal sizing and selection of the redo THV.
• Assessment of index THV characteristics and alignment is critical for successful redo TAVR.

Conclusions:

• Cardiac CT is indispensable for evaluating THV failure and planning redo TAVR.
• Understanding differences in CT assessment for redo TAVR is vital for procedural success.
• CT guides decisions impacting coronary access and potential leaflet modification in redo TAVR.