Role of Computed Tomography in Transcatheter Aortic Valve Replacement

Abstract

ABSTRACT The rapid development of transcatheter aortic valve replacement (TAVR) and its widespread adoption has heavily relied on rapid innovations in interventional cardiology and cardiovascular imaging. With a furious pace of evolution of data in recent years, the field has moved dramatically forward to a point of widespread acceptance and routine performance in an outpatient setting or a non-urgent inpatient setting. From its earliest iteration, it was recognized that a "heart team," which comprised of cardiologists (valve specialists, imaging specialists and interventionalists) and cardiac surgeons was crucial for successful execution of a TAVR procedure. Additionally, it was also recognized that careful pre-procedural planning was also imperative in its success. This has led to the burgeoning field of multimodality structural and interventional imaging, which coincided with the maturation of modern imaging techniques such as 3D echocardiography, ECG gated multi-detector computed tomography (MDCT) and cardiac magnetic resonance imaging (CMR). Of these, MDCT has gained particular importance in the context of preprocedural planning in the setting of TAVR and its integration has been critical for its success. The current article is a state-of-the-art review of the role of MDCT in the context of TAVR. With the emergence of valve-in-valve TAVR, there will be evolution of newer details to be reported on a preprocedural MDCT; however these are beyond the scope of this article.