Author + information
- Received December 23, 2017
- Revision received October 15, 2018
- Accepted October 18, 2018
- Published online May 15, 2019.
- Jeroen J. Bax, MD, PhDa,∗ (, )
- Victoria Delgado, MD, PhDa,
- Rebecca T. Hahn, MDb,
- Jonathon Leipsic, MD, PhDc,
- James K. Min, MDd,
- Paul Grayburn, MDe,
- Lars Sondergaard, MD, DMScf,
- Sung-Han Yoon, MDg and
- Stephan Windecker, MDh
- aDepartment of Cardiology, Leiden University Medical Center, Leiden, the Netherlands
- bColumbia University Medical Center, NY Presbyterian Hospital, New York, New York
- cDepartment of Radiology and Division of Cardiology, Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
- dDepartment of Radiology, The New York-Presbyterian Hospital and the Weill Cornell Medical College, New York, New York
- eBaylor Heart and Vascular Institute and the Division of Cardiology, Department of Internal Medicine, Baylor University Medical Center, Dallas, Texas
- fThe Heart Center, Rigshospitalet, University of Copenhagen, Denmark
- gDepartment of Interventional Cardiology, Cedars-Sinai Heart Institute, Los Angeles, California
- hDepartment of Cardiology, Bern University Hospital, Inselspital, University of Bern, Bern, Switzerland
- ↵∗Address for correspondence:
Dr. Jeroen J. Bax, Department of Cardiology, Leiden University Medical Center, Albinusdreef 2 2333 ZA Leiden, the Netherlands.
• TAVR is an established therapy for patients with symptomatic severe AS.
• This therapy is safe and feasible in bicuspid AS, degenerated bioprostheses, and aortic regurgitation.
• CT is becoming the central imaging technique to plan the procedure.
• Multimodality imaging integrating functional and anatomical information expands this technique to complex clinical scenarios.
Transcatheter aortic valve replacement (TAVR) is an established therapy for patients with symptomatic severe aortic stenosis. Technological advances and the learning curve have resulted in better procedural results in terms of hemodynamic valve performance and intermediate-term clinical outcomes. The integration of anatomical and functional information provided by multimodality imaging has improved size selection of TAVR prostheses, permitted better patient selection, and provided new insights in the performance of the TAVR prostheses at follow-up. Furthermore, the field of TAVR continues to develop and expand the technique to younger patients with lower risk on the one hand, and more complex clinical scenarios, on the other hand, such as degenerated aortic bioprostheses, bicuspid aortic valves, or pure native aortic regurgitation. The present review article summarizes how multimodality imaging can be integrated in TAVR in clinical (sometimes complex) scenarios that have not been included in the landmark randomized clinical trials.
- aortic regurgitation
- bicuspid aortic valve
- multi-detector row computed tomography
- transcatheter aortic valve replacement
The Department of Cardiology, Leiden University Medical Center has received unrestricted research grants from Biotronik, Medtronic, Boston Scientific, GE Healthcare, and Edwards Lifesciences. Dr. Bax has received speaker fees from Abbott Vascular and Boehringer Ingelheim. Dr. Delgado has received speaker fees from Abbott Vascular. Dr. Leipsic has received institutional support through core laboratory services for Edwards Lifesciences, Medtronic, Abbott, and Neovasc; and serves as a consultant for Circle CVI and Heartflow. Dr. Windecker has received research and educational grants to the institution from Abbott, Amgen, Bayer, Bristol-Myers Squibb, Biotronik, Boston Scientific, CSL, Edwards, Medtronic, Sinomed, and Polares. Dr. Hahn has received speaker fees from Boston Scientific Corporation and Baylis Medical; consulting for Abbott Structural, Edwards Lifesciences, Gore&Associates, Medtronic, Navigate, Philips Healthcare, and Siemens Healthcare; non-financial support from 3mensio and GE Healthcare; is Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. Dr. Sondergaard has received consultant fees and institutional research grants from Abbott, Boston Scientific, Edwards Lifesciences, and Medtronic. Dr. Min is on the Scientific Advisory Board of Arineta; has ownership in MDDX; and has a research agreement with GE Healthcare. Dr. Grayburn has received research grants Boston Scientific and under Core Lab contracts, Valtech Cardio is now Edwards Lifesciences.
- Received December 23, 2017.
- Revision received October 15, 2018.
- Accepted October 18, 2018.
- 2019 American College of Cardiology Foundation
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