The contribution of Computed Tomography for the planning of Transcatheter Aortic Valve Implantation. An overview of required measurements and their use

Myrsini Stasinopoulou, Nefeli Andrioti Petropoulou, Constantinos Deliveliotis


Transcatheter aortic valve implantation (TAVI) is an alternative treatment for inoperable patients with symptomatic severe aortic valve stenosis. This procedure is a validated and effective treatment option with increasingly clinical implementation in the last decade. The careful selection of TAVI candidates is of great importance for a successful procedure and can be achieved with the contribution of Computed Tomography (CT), as CT is the main imaging method that provides information required for the selection of bio-prosthesis and the access routes. CT pre-TAVI includes specified measurements of the aortic valvular complex on reconstructed CT images in the true plane of the aortic annulus and also the investigation of possible endovascular or extravascular access routes. The CT scanning protocol and the contrast agent dose must be modified in such a way to provide high-quality CT images with a minimum of contrast amount, regarding the advanced age patients. There are advantages and limitations of CT-examination that will be discussed. Finally, the derived results of CT pre-TAVI have to be reported in a template to facilitate communication between radiologists and cardiologists.


Transcatheter aortic valve implantation; Computed Tomography; Aortic valve stenosis

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Nkomo VT, Gardin JM, Skelton TN, et al. Burden of valvular heart diseases: a population-based study. Lancet 2006; 368(9540): 1005–11.

Iung B, Cachier A, Baron G, et al. Decision-making in elderly patients with severe aortic stenosis: why are so many denied surgery? Eur Heart J 2005; 26(24): 2714–20

Ribeiro HB, Webb JG, Makkar RR, et al. Predictive factors, management, and clinical outcomes of coronary obstruction following transcatheter aortic valve implantation: insights from a large multi-center registry. J Am Coll Cardiol 2013; 62: 1552-1562.

Hines GL, Jaspan V, Kelly BJ, et al. Vascular Complications Associated with Transfemoral Aortic Valve Replacement. Int J Angiol 2016; 25: 99-103.

Bauernschmitt R, Schreiber C, Bleiziffer S, et al. Transcatheter aortic valve implantation through the ascending aorta: an alternative option for no-access patients. Heart Surg Forum 2009; 12(1): E63–E64.

Bruschi G, De Marco F, Fratto P, et al. Direct aortic access through right minithoracotomy for implantation of self-expanding aortic bioprosthetic valves. J Thorac Cardiovasc Surg 2010; 140 (3): 715–717.

Stortecky S, Buellesfeld L, Wenaweser P, et al. Transcatheter aortic valve implantation: the procedure. Heart 2012; 98(suppl 4): iv44–iv51.

Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2017; 38: 2739–2791.

Nishimura RA, Otto CM, Bonow RO, et al. AHA/ACC guideline for the management of patients with valvular heart disease: executive summary: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. Circulation. 2014; 129: 2440–2492.

Otto CM, Kumbhani DJ, Alexander KP, et al. ACC expert consensus decision pathway for transcatheter aortic valve replacement in the management of adults with aortic stenosis: a report of the American College of Cardiology Task Force on Clinical Expert Consensus Documents. J Am Coll Cardiol 2017; 69: 1313–1346.

Francone M, Budde RPJ, Bremerich J, et al. CT and MR imaging prior to transcatheter aortic valve implantation: standardisation of scanning protocols, measurements and reporting-a consensus document by the European Society of Cardiovascular Radiology (ESCR) Eur Radiol 2020; 30(5): 2627–2650.

Clavel MA, Pibarot P, Messika-Zeitoun D et al. () Impact of aortic valve calcification, as measured by MDCT, on survival in patients with aortic stenosis: results of an international registry study. J Am Coll Cardiol 2014; 64: 1202–1213.

Aggarwal SR, Clavel MA, Messika-Zeitoun D et al. Sex differences in aortic valve calcification measured by multidetector computed tomography in aortic stenosis. Circ Cardiovasc Imaging 2013; 6: 40–47.

Scherner M, Wahlers T.Acute kidney injury after transcatheter aortic valve implantation. J Thorac Dis 2015; 7: 1527–1535.

Salgado RA, Leipsic JA, Shivalkar B, et al. Preprocedural CT evaluation of transcatheter aortic valve replacement: what the radiologist needs to know. RadioGraphics 2014; 34(6): 1491–1514.

Bertaso AG, Wong DT, Liew GY, et al. Aortic annulus dimension assessment by computed tomography for transcatheter aortic valve implantation: differences between systole and diastole. Int J Cardiovasc Imaging 2012; 28(8): 2091–2098.

Sucha D, Tuncay V, Prakken NH et al. Does the aortic annulus undergo conformational change throughout the cardiac cycle? A systematic review. Eur Heart J Cardiovasc Imaging 2015; 16: 1307–1317.

Kok M, Turek J, Mihl C et al. Low contrast media volume in pre-TAVI CT examinations. Eur Radiol 2016; 26: 2426–2435.

Schueller-Weidekamm C, Schaefer-Prokop CM, Weber M, et al. CT angiography of pulmonary arteries to detect pulmonary embolism: improvement of vascular enhancement with low kilovoltage settings. Radiology 2006; 241(3): 899–907.

Perlman GY, Blanke P, Webb JG () Transcatheter aortic valve implantation in bicuspid aortic valve stenosis. Euro Intervention 2016; 12: Y42–Y45.

Haensig M, Rastan AJ Aortic valve calcium load before TAVI: is it important? Ann Cardiothorac Surg. 2012; 1: 160–164 46.

Fassa AA, Himbert D, Vahanian A. Mechanisms and management of TAVR-related complications. Nat Rev Cardiol 2013; 10: 685– 695.

Latsios George, Themistoklis N. Spyridopoulos, Konstantinos Toutouzas, et al. Multi-slice CT (MSCT) imaging in pretrans-catheter aortic valve implantation (TAVI) screening. How to perform and how to interpret. Hellenic J Cardiol 2018; 59: p.3e7,10.1016/ j.hjc. 2017.09.013

von Aspern K, Foldyna B, Etz CD, et al. Effective diameter of the aortic annulus prior to transcatheter aortic valve implantation: influence of area-based versus perimeter-based calculation. Int J Cardiovasc Imaging. 2015; 31: 163-169.

Schmidkonz C, Marwan M, Klinghammer L, et al. Interobserver variability of CT angiography for evaluation of aortic annulus dimensions prior to transcatheter aortic valve implantation (TAVI). Eur J Radiol 2014; 83: 1672-1678.

Khatri PJ, Webb JG, Rodes-Cabau J et al Adverse effects associated with transcatheter aortic valve implantation: a meta-analysis of contemporary studies. Ann Intern Med 2013; 158: 35–46.

Achenbach S, Delgado V, Hausleiter J, et al. SCCT expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR). J Cardiovasc Comput Tomogr 2012; 6: 366–380.

Kurra V, Kapadia SR, Tuzcu EM, et al. Pre-procedural imaging of aortic root orientation and dimensions: comparison between x-ray angiographic planar imaging and 3-dimensional multidetector row computed tomography. JACC Cardiovasc Interv 2010; 3(1): 105–113.

Gurvitch R, Wood DA, Leipsic J, et al. Multislice computed tomography for prediction of optimal angiographic deployment projections during transcatheter aortic valve implantation. JACC Cardiovasc Interv 2010; 3(11): 1157–1165.

Tzikas A, Schultz C, Van Mieghem NM, et al. Optimal projection estimation for transcatheter aortic valve implantation based on contrast-aortography: validation of a prototype software. Catheter Cardiovasc Interv 2010; 76(4): 602–607.

Hayashida K, Lefevre T, Chevalier B, et al. Transfemoral aortic valve implantation new criteria to predict vascular complications. JACC Cardiovasc Interv 2011; 4: 851-858.

Latsios G, Toutouzas K, Tousoulis D, et al. Jamming of the 18F sheath’s tip inside a severely calcified femoral artery. Int J Cardiol 2013; 166: 48-49.

Vahanian A, Alfieri O, Al-Attar N, et al. Transcatheter valve implantation for patients with aortic stenosis: a position statement from the European Association of Cardio-Thoracic Surgery (EACTS) and the European Society of Cardiology (ESC), in collaboration with the European Association of Percutaneous Cardiovascular Interventions (EAPCI). EuroIntervention 2008; 4(2): 193–199.

Ben-Dor I, Waksman R, Hanna NN, et al. Utility of radiologic review for noncardiac findings on multislice computed tomography in patients with severe aortic stenosis evaluated for transcatheter aortic valve implantation. Am J Cardiol 2010; 105(10): 1461–1464.

Trenkwalder T, Lahmann AL, Nowicka M et al. Incidental findings in multislice computed tomography prior to transcatheter aortic valve implantation: frequency, clinical relevance and outcome. Int J Cardiovasc Imaging. 2018 018-1305-5.

Gilard M, Eltchaninoff H, Jung B, et al. Registry of transcatheter aortic-valve implantation in high-risk patients. N Engl J Med. 2012; 366: 1705-1715.

Goel SS, Ige M, Tuzcu EM, et al. Severe aortic stenosis and coronary artery disease - implications for management in the transcatheter aortic valve replacement era: a comprehensive review. J Am Coll Cardiol 2013; 62: 1-10.



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