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Computed tomography to guide transcatheter aortic valve implantation

Computertomographie zur periinterventionellen Diagnostik der Transkatheter-Aortenklappenimplantation

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Abstract

Since its introduction in 2022, transcatheter aortic valve implantation (TAVI) has revolutionized the treatment and prognosis of patients with aortic stenosis. Robust clinical trial data and a wealth of scientific evidence support its efficacy and safety. One of the key factors for success of the TAVI procedure is careful preprocedural planning using imaging. Computed tomography (CT) has developed into the standard imaging method for comprehensive patient assessment in this context. Suitability of the femoral and iliac arteries for transfemoral access, exact measurement of aortic annulus size and geometry as the basis for prosthesis selection, quantification of the spatial relationship of the coronary ostia to the aortic annular plane, and identification of optimal fluoroscopic projection angles for the implantation procedure are among the most important information that can be gained from preprocedural CT. Further research is aimed at improving risk stratification, for example, with respect to annular perforation, periprosthetic aortic regurgitation, and need for postprocedural implantation of a permanent pacemaker.

Zusammenfassung

Seit ihrer Einführung im Jahr 2022 hat die Transkatheter-Aortenklappenimplantation (TAVI) die Behandlung und Prognose von Patientinnen und Patienten mit Aortenklappenstenose revolutioniert. Belastbare klinische Studiendaten und umfangreiche wissenschaftliche Evidenz belegen Effektivität und Sicherheit. Einer der Schlüsselfaktoren für den Erfolg des TAVI-Verfahrens ist die sorgfältige Planung vor dem Eingriff anhand bildgebender Verfahren. Die Computertomographie (CT) hat sich dafür zum Standardbildgebungsverfahren für die umfassende periinterventionelle Diagnostik entwickelt. Die Eignung der femoralen und iliakalen Arterien für den transfemoralen Zugang, die genaue Bestimmung von Größe und Geometrie des Aortenannulus als Grundlage für die Prothesenauswahl, die Quantifizierung der räumlichen Beziehung der Koronarostien zur Aortenannulusebene und die Identifizierung optimaler fluoroskopischer Projektionswinkel für das Implantationsverfahren zählen zu den wesentlichsten Informationen, die sich aus der präprozeduralen CT ergeben. Weitere Forschung zielt darauf ab, die Risikostratifizierung zu verbessern, z. B. in Bezug auf die Annulusperforation, die periprothetische Aortenregurgitation und die Notwendigkeit für die postprozedurale Implantation eines permanenten Schrittmachers.

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  1. Medizinische Klinik 2, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany

    Marwa Daghem, Florian Weidinger &  Stephan Achenbach

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M. Daghem, F. Weidinger and S. Achenbach declare that they have no competing interests.

For this article no studies with human participants or animals were performed by any of the authors. All studies mentioned were in accordance with the ethical standards indicated in each case.

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Daghem, M., Weidinger, F. & Achenbach, S. Computed tomography to guide transcatheter aortic valve implantation. Herz 48, 359–365 (2023). https://doi.org/10.1007/s00059-023-05203-4

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