Emerging real-world evidence underscores how contrast-enhanced computed tomography (CT) imaging before transcatheter aortic valve replacement (TAVR) can transform procedural planning and reduce complications in patients with severe aortic atheroma.
Cardiologists specializing in structural heart disease now confront a critical challenge: optimizing outcomes in TAVR candidates with extensive aortic atheroma. The distribution, composition and severity of atheromatous plaques within the thoracic aorta significantly influence procedural risk, from vascular injury to periprocedural ischemic stroke and acute kidney injury. Advanced TAVR imaging techniques optimize preprocedural assessments by precisely characterizing plaque burden, ensuring that aortic atheroma severity plays a crucial role in procedural planning. Contrast-enhanced CT has emerged as an essential tool for this purpose.
This level of anatomical detail underpins strategic decision-making on device selection and procedural approach. As previously reported, CT-derived reconstructions of aortic valve anatomy guide accurate transcatheter heart valve sizing, refine choice of vascular access routes and minimize paravalvular regurgitation. Cardiology imaging protocols that incorporate high-resolution CT data now form the backbone of transcatheter aortic valve replacement workflow, balancing the demands of efficient delivery with patient-specific anatomic nuances.
Predicting and mitigating periprocedural ischemic stroke requires targeted evaluation of embolic sources. Building on those observations, detailed preprocedural computed tomography (CT) scans enable identification of static plaque features such as ulceration and severe calcification that may precipitate cerebrovascular events during valve deployment; however, detection of mobile debris requires echocardiographic evaluation or other modalities. Preprocedural strategies aim to mitigate these risks through tailored antithrombotic regimens and selective use of cerebral protection devices, aligning with current guidelines from professional societies such as the American College of Cardiology (ACC) and the American Heart Association (AHA) regarding antithrombotic therapy and cerebral protection device indications in transcatheter aortic valve replacement (TAVR).
By addressing aortic atheroma in TAVR through innovation, these imaging protocols not only reduce TAVR adverse events but also expand patient eligibility. These developments reflect the significant impact of CT advancements in heart valve procedures, offering improved patient care through enhanced imaging capabilities. As access to high-resolution imaging becomes more widespread, clinicians may offer minimally invasive valve interventions to patients with multifocal vascular disease or borderline renal function; however, strategies to mitigate contrast-induced nephropathy, such as adequate hydration and minimizing contrast volume, should be considered when imaging these patients, or alternative noncontrast imaging modalities may be discussed.
Key Takeaways:- Contrast-enhanced CT is critical in reducing procedural risks by assessing aortic atheroma severity.
- Preprocedural imaging guides crucial aspects of TAVR, such as device selection and procedural strategies.
- Advanced imaging allows for precise identification of high-risk anatomical features to mitigate ischemic stroke risks.
- Continued advancements in imaging are likely to expand the benefits of TAVR to broader patient populations.