TRANSCATHETER AORTIC VALVE IMPLANTATION: PREOPERATIVE WORKUP AND INDICATIONS FOR INTERVENTION

Veysel Ozan Tanık1 Bülent Özlek2 Yusuf Taşkın3

1Etlik City Hospital, Department of Cardiology, Ankara, Türkiye
2Muğla Sıtkı Koçman University, Faculty of Medicine, Department of Cardiology, Muğla, Türkiye
3Etlik City Hospital, Department of Cardiology, Ankara, Türkiye

Tanık VO, Özlek B, Taşkın Y. Transcatheter Aortic Valve Implantation: Preoperative Workup and Indications for Intervention. In: Tanık VO, Özlek B, editors. Invasive Interventions in Structural Heart Diseases: Comprehensive Techniques. 1st ed. Ankara: Türkiye Klinikleri; 2025. p.179-204.

ABSTRACT

Transcatheter Aortic Valve Implantation (TAVI) has become a vital treatment option for elderly and high-risk patients suffering from severe aortic stenosis. This minimally invasive procedure, which involves catheter-based placement of the aortic valve, serves as a viable alternative to traditional open-heart surgery. A comprehensive preoperative assessment is critical for successfully implementing TAVI, encompassing accurate patient selection, optimal device sizing, and careful access route planning. This chapter offers an in-depth review of the preoperative evaluation process for TAVI, covering anatomical considerations, advanced imaging techniques, procedural indications, and patient eligibility criteria. Diligent assessment of aortic anatomy, precise determination of vascular access, and strategies for risk mitigation are essential for optimizing outcomes. TAVI presents a safe and effective therapeutic option for appropriately selected patients.

Keywords: Transcatheter aortic valve implantation; Aortic valve stenosis; Pre-operatif

Referanslar

  1. Pujari SH, Agasthi P. Aortic stenosis. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2020. [Link]
  2. Baumgartner H, Hung J, Bermejo J, et al. Echocardiographic assessment of valve stenosis: EAE/ASE recommendations for clinical practice. Eur J Echocardiogr. 2009;10(1):1-25. [Crossref]  [PubMed]
  3. Venturi G, Pighi M, Pesarini G, Ferrero V, Lunardi M, Castaldi G, et al. Contrast-induced acute kidney injury in patients undergoing TAVI compared with coronary interventions. J Am Heart Assoc. 2020;9(24):e017194. [Crossref]  [PubMed]  [PMC]
  4. Clavel MA, Malouf J, Michelena HI, Suri RM, Jaffe AS, Mahoney DW, et al. B-type natriuretic peptide clinical activation in aortic stenosis: impact on long-term survival. J Am Coll Cardiol. 2014;63(19):2016-2025. [Crossref]  [PubMed]
  5. Otto CM, Nishimura RA, Bonow RO, Carabello BA, Erwin JP, Gentile F, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: a report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020;142(5):e72-e227. [Crossref]  [PubMed]
  6. Vahanian A, Beyersdorf F, Praz F, Milojevic M, Baldus S, Bauersachs J, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease: developed by the task force for the management of valvular heart disease of the European Society of Cardiology (ESC) and the European Association for Cardio-Thoracic Surgery (EACTS). Eur Heart J. 2022;43(7):561-632. [Link]
  7. Monin JL, Quéré JP, Monchi M, et al. Low-gradient aortic stenosis: operative risk stratification and predictors for long-term outcome: a multicenter study using dobutamine stress hemodynamics. Circulation. 2003;108(3):319-324. [Link]
  8. Levy F, Laurent M, Monin JL, Maillet JM, Pasquet A, Le Tourneau T, et al. Aortic valve replacement for low-flow/ low-gradient aortic stenosis: operative risk stratification and long-term outcome: a European multicenter study. J Am Coll Cardiol. 2008;51(15):1466-1472. [Crossref]  [PubMed]
  9. Clavel MA, Pibarot P, Messika-Zeitoun D, Capoulade R, Malouf J, Aggarval S, 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(12):1202-1213. [Crossref]  [PubMed]  [PMC]
  10. Cueff C, Serfaty JM, Cimadevilla C, Laissy JP, Himbert D, Tubach F, et al. Measurement of aortic valve calcification using multislice computed tomography: correlation with haemodynamic severity of aortic stenosis and clinical implication for patients with low ejection fraction. Heart. 2011;97(9):721-726. [Crossref]  [PubMed]
  11. Pawade T, Clavel MA, Tribouilloy C, Dreyfus J, Mathieu T, Tastet L, et al. Computed tomography aortic valve calcium scoring in patients with aortic stenosis. Circ Cardiovasc Imaging. 2018;11(6):e007146. [Link]
  12. Blanke P, Euringer W, Baumann T, Reinöhl J, Schlensak C, Langer M, et al. Combined assessment of aortic root anatomy and aortoiliac vasculature with dual-source CT as a screening tool in patients evaluated for transcatheter aortic valve implantation. Am J Roentgenol. 2010;195(5):872-881. [Crossref]  [PubMed]
  13. Francone M, Budde RPJ, Bremerich J, Dacher JN, Loewe C, Wolf F, 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. [Crossref]  [PubMed]  [PMC]
  14. Schwarz F, Lange P, Zinsser D, Greif M, Boekstegers P, Schmitz C, et al. CT-angiography-based evaluation of the aortic annulus for prosthesis sizing in transcatheter aortic valve implantation (TAVI): predictive value and optimal thresholds for major anatomic parameters. PLoS One. 2014;9(5):e103481. [Crossref]  [PubMed]  [PMC]
  15. 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. [Crossref]  [PubMed]
  16. Salgado RA, Budde RP, Leiner T, et al. Transcatheter aortic valve replacement: postoperative CT findings of Sapien and CoreValve transcatheter heart valves. Radiographics. 2014;34(6):1517-1536. [Crossref]  [PubMed]
  17. 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(12):1307-1317. [Link]
  18. Perlman GY, Blanke P, Webb JG. Transcatheter aortic valve implantation in bicuspid aortic valve stenosis. EuroIntervention. 2016;12(1):Y42-Y45. [Crossref]  [PubMed]
  19. Jilaihawi H, Chen M, Webb J, et al. A bicuspid aortic valve imaging classification for the TAVR era. JACC Cardiovasc Imaging. 2016;9(10):1145-1158. [Link]
  20. Wijesinghe N, Ye J, Rodes-Cabau J, et al. Transcatheter aortic valve implantation in patients with bicuspid aortic valve stenosis. JACC Cardiovasc Interv. 2010;3(10):1122-1125. [Crossref]  [PubMed]
  21. Haensig M, Rastan AJ. Aortic valve calcium load before TAVI: is it important? Ann Cardiothorac Surg. 2012;1(3):160-164. [Link]
  22. Fassa AA, Himbert D, Vahanian A. Mechanisms and management of TAVR-related complications. Nat Rev Cardiol. 2013;10(11):685-695. [Crossref]  [PubMed]
  23. Haensig M, Rastan AJ. Aortic valve calcium load before TAVI: is it important? Ann Cardiothorac Surg. 2012;1(3):160-164. [Link]
  24. Horehledova B, Mihl C, Hendriks BMF, et al. Do CTA measurements of annular diameter, perimeter and area result in different TAVI prosthesis sizes? Int J Cardiovasc Imaging. 2018;34(12):1819-1829. [Crossref]  [PubMed]  [PMC]
  25. Pibarot P, Magne J, Leipsic J, Côté N et al. Imaging for Predicting and Assessing Prosthesis-Patient Mismatch After Aortic Valve Replacement. JACC Cardiovasc Imaging. 2019 Jan;12(1):149-162. [Crossref]  [PubMed]
  26. Aoun J, Zaid S, Goel S, Reardon MJ. A Comprehensive Evaluation of the NAVITOR Transcatheter Aortic Valve Replacement System. Heart Int. 2024 Apr 9;18(1):26-29. [Crossref]  [PubMed]  [PMC]
  27. Dvir D, Webb J, Brecker S, et al. Transcatheter aortic valve replacement for degenerative bioprosthetic surgical valves: Results from the global valve-in-valve registry. Circulation. 2012;126(19):2335-2344. [Crossref]  [PubMed]
  28. 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(1):35-46. [Crossref]  [PubMed]
  29. Bagur R, Dumont E, Doyle D, et al. Coronary ostia stenosis after transcatheter aortic valve implantation. JACC Cardiovasc Interv. 2010;3(3):253-255. [Crossref]  [PubMed]
  30. Giustino G, Montorfano M, Chieffo A, et al. Tardive coronary obstruction by a native leaflet after transcatheter aortic valve replacement in a patient with heavily calcified aortic valve stenosis. JACC Cardiovasc Interv. 2014;7(10):e105-e107. [Crossref]  [PubMed]
  31. 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. [Crossref]  [PubMed]
  32. 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(6):366-380. [Crossref]  [PubMed]
  33. Blanke P, Schoepf UJ, Leipsic JA. CT in transcatheter aortic valve replacement. Radiology. 2013;269(3):650-669. [Crossref]  [PubMed]
  34. Sherif MA, Abdel-Wahab M, Stöcker B, et al. Anatomic and procedural predictors of paravalvular aortic regurgitation after implantation of the Medtronic CoreValve bioprosthesis. J Am Coll Cardiol. 2010;56(20):1623-1629. [Crossref]  [PubMed]
  35. Abramowitz Y, Maeno Y, Chakravarty T, et al. Aortic Angulation Attenuates Procedural Success Following Self-Expandable But Not Balloon-Expandable TAVR. JACC Cardiovasc Imaging. 2016;9(8):964-972. [Crossref]  [PubMed]
  36. Adams DH, Popma JJ, Reardon MJ, Yakubov SJ, Coselli JS, Deeb GM, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N Engl J Med. 2014;370(19):1790-8. [Crossref]  [PubMed]
  37. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med. 2011;364(23):2187-98. [Crossref]  [PubMed]
  38. Tretter JT, Mori S, Anderson RH, et al. Anatomical predictors of conduction damage after transcatheter implantation of the aortic valve. Open Heart. 2019;6(1):e000972. [Crossref]  [PubMed]  [PMC]
  39. Pellegrini C, Freißmuth M, Rheude T, et al. Implantation depth of balloon-expandable transcatheter heart valves and risks for permanent pacemaker implantation and midterm adverse events. Catheter Cardiovasc Interv. 2023;102(7):1301-1310. [Crossref]  [PubMed]
  40. Kikuchi S, Minamimoto Y, Matsushita K, et al. Impact of New-Onset Right Bundle-Branch Block After Transcatheter Aortic Valve Replacement on Permanent Pacemaker Implantation. J Am Heart Assoc. 2024;13(9):e032777. [Crossref]  [PubMed]  [PMC]
  41. Jørgensen TH, Hansson N, De Backer O, et al. Membranous septum morphology and risk of conduction abnormalities after transcatheter aortic valve implantation. EuroIntervention. 2022;17(13):1061-1069. [Crossref]  [PubMed]  [PMC]
  42. Blanke P, Soon J, Dvir D, et al. Computed tomography assessment for transcatheter aortic valve in valve implantation: the Vancouver approach to predict anatomical risk for coronary obstruction and other considerations. J Cardiovasc Comput Tomogr. 2016;10(6):491-499. [Crossref]  [PubMed]
  43. Blanke P, Weir-McCall JR, Achenbach S, et al. Computed tomography imaging in the context of transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR): An expert consensus document of the Society of Cardiovascular Computed Tomography. J Cardiovasc Comput Tomogr. 2019;13(1):1-20. [Crossref]  [PubMed]
  44. Reinthaler M, Aggarwal SK, De Palma R, et al. Predictors of clinical outcome in transfemoral TAVI: Circumferential iliofemoral calcifications and manufacturer-derived recommendations. Anatol J Cardiol. 2015;15(4):297-305. [Crossref]  [PubMed]  [PMC]
  45. Teitelbaum M, Kotronias RA, Sposato LA, et al. Cerebral Embolic Protection in TAVI: Friend or Foe. Interv Cardiol. 2019;14(1):22-25. [Crossref]  [PubMed]  [PMC]
  46. Tagliari AP, Saadi RP, Ferrari E, et al. The Role of the Axillary Artery as a Second Access Choice in TAVI Procedures. Braz J Cardiovasc Surg. 2021;36(2):237-243. [Crossref]  [PubMed]
  47. Pighi M, Giovannini D, Scarsini R, et al. Diagnostic WorkUp of the Aortic Patient: An Integrated Approach toward the Best Therapeutic Option. J Clin Med. 2021;10(21):5120. [Crossref]  [PubMed]  [PMC]
  48. Buchner S, Debl K, Schmid FX, et al. Cardiovascular magnetic resonance assessment of the aortic valve stenosis: an in vivo and ex vivo study. BMC Med Imaging. 2015;15:47. [Crossref]  [PubMed]  [PMC]
  49. Baumgartner H, Falk V, Bax JJ, et al. 2017 ESC/EACTS Guidelines for the management of valvular heart disease. Eur Heart J. 2017;38(37):2739-2791. [PubMed]
  50. Yatsynovich Y, Khattak H, Ali M, et al. Comparison of transcatheter aortic valve replacement risk score against currently accepted surgical risk models as predictors of 30-day mortality in transcatheter aortic valve replacement. J Interv Cardiol. 2017;30(6):595-603. [Crossref]  [PubMed]
  51. Beohar N, Whisenant B, Kirtane AJ, Leon MB, Tuzcu EM, Makkar R, et al. The relative performance characteristics of the logistic European system for cardiac operative risk evaluation score and the society of thoracic surgeons score in the placement of aortic transcatheter valves trial. J Thorac Cardiovasc Surg. 2014;148:2830.e1-2837.e1. [Crossref]  [PubMed]
  52. Fried LP, Tangen CM, Walston J, Newman AB, Hirsch C, Gottdiener J, et al. Frailty in older adults: Evidence for a phenotype. J Gerontol A Biol Sci Med Sci. 2001;56:M146-M156. [Crossref]  [PubMed]
  53. Kundi H, Popma JJ, Reynolds MR, Strom JB, Pinto DS, Valsdottir LR, et al. Frailty and related outcomes in patients undergoing transcatheter valve therapies in a nationwide cohort. Eur Heart J. 2019;40:2231-2239. [Crossref]  [PubMed]  [PMC]
  54. Dent E, Martin FC, Bergman H, Woo J, Romero-Ortuno R, Walston JD. Management of frailty: opportunities, challenges, and future directions. Lancet. 2019;394:1376-1386. [Crossref]  [PubMed]
  55. Green P, Arnold SV, Cohen DJ, Kirtane AJ, Kodali SK, Brown DL, et al. Relation of frailty to outcomes after transcatheter aortic valve replacement (from the PARTNER trial). Am J Cardiol. 2015;116:264-269. [Crossref]  [PubMed]  [PMC]
  56. Shelkey M, Wallace M. Katz Index of Independence in Activities of Daily Living. J Gerontol Nurs. 1999;25:8-9. [Crossref]  [PubMed]
  57. Lindman BR, Alexander KP, O'Gara PT, Afilalo J. Futility, benefit, and transcatheter aortic valve replacement. JACC Cardiovasc Interv. 2014;7:707-716. [Crossref]  [PubMed]  [PMC]
  58. Sato K, Sankaramangalam K, Kandregula K, Bullen JA, Kapadia SR, Krishnaswamy A, et al. Contemporary outcomes in low-gradient aortic stenosis patients who underwent dobutamine stress echocardiography. J Am Heart Assoc. 2019;8:e011168. [Crossref]  [PubMed]  [PMC]
  59. Clavel MA, Dumesnil JG, Capoulade R, Mathieu P, Senechal M, Pibarot P. Outcome of patients with aortic stenosis, small valve area, and low-flow, low-gradient despite preserved left ventricular ejection fraction. J Am Coll Cardiol. 2012;60:1259-1267. [Crossref]  [PubMed]
  60. Mehrotra P, Jansen K, Flynn AW, Tan TC, Elmariah S, Picard MH, et al. Differential left ventricular remodelling and longitudinal function distinguishes low flow from normal-flow preserved ejection fraction low-gradient severe aortic stenosis. Eur Heart J. 2013;34:1906-1914. [Crossref]  [PubMed]  [PMC]
  61. Tribouilloy C, Rusinaru D, Marechaux S, Castel AL, Debry N, Maizel J, et al. Low-gradient, low-flow severe aortic stenosis with preserved left ventricular ejection fraction: characteristics, outcome, and implications for surgery. J Am Coll Cardiol. 2015;65:55-66. [Crossref]  [PubMed]
  62. Chadha G, Bohbot Y, Rusinaru D, Marechaux S, Tribouilloy C. Outcome of normal-flow low-gradient severe aortic stenosis with preserved left ventricular ejection fraction: a propensity-matched study. J Am Heart Assoc. 2019;8:e012301. [Crossref]  [PubMed]  [PMC]
  63. Yoon SH, Bleiziffer S, De Backer O, Delgado V, Arai T, Ziegelmueller J, et al. Outcomes in transcatheter aortic valve replacement for bicuspid versus tricuspid aortic valve stenosis. J Am Coll Cardiol. 2017;69:2579-2589. [Link]
  64. Halim SA, Edwards FH, Dai D, Li Z, Mack MJ, Holmes DR, et al. Outcomes of transcatheter aortic valve replacement in patients with bicuspid aortic valve disease: a report from the Society of Thoracic Surgeons/American College of Cardiology Transcatheter Valve Therapy Registry. Circulation. 2020;141:1071-1079. [Crossref]  [PubMed]
  65. Forrest JK, Kaple RK, Ramlawi B, Gleason TG, Meduri CU, Yakubov SJ, et al. Transcatheter aortic valve replacement in bicuspid versus tricuspid aortic valves from the STS/ACC TVT Registry. JACC Cardiovasc Interv. 2020;13:1749-1759. [Crossref]  [PubMed]
  66. Lancellotti P, Magne J, Dulgheru R, Clavel MA, Donal E, Vannan MA, et al. Outcomes of patients with asymptomatic aortic stenosis followed up in heart valve clinics. JAMA Cardiol. 2018;3:1060-1068. [Crossref]  [PubMed]  [PMC]
  67. Rafique AM, Biner S, Ray I, Forrester JS, Tolstrup K, Siegel RJ. Meta-analysis of prognostic value of stress testing in patients with asymptomatic severe aortic stenosis. Am J Cardiol. 2009;104:972-977. [Crossref]  [PubMed]
  68. Genereux P, Stone GW, O'Gara PT, Marquis-Gravel G, Redfors B, Giustino G, et al. Natural history, diagnostic approaches, and therapeutic strategies for patients with asymptomatic severe aortic stenosis. J Am Coll Cardiol. 2016;67:2263-2288. [Crossref]  [PubMed]
  69. Bohbot Y, Kowalski C, Rusinaru D, Ringle A, Marechaux S, Tribouilloy C. Impact of mean transaortic pressure gradient on long-term outcome in patients with severe aortic stenosis and preserved left ventricular ejection fraction. J Am Heart Assoc. 2017;6. [Crossref]  [PubMed]  [PMC]