Computed Tomography Imaging In The Context Of Transcatheter Aortic Valve Implantation (TAVI) / Transcatheter Aortic Valve Replacement (TAVR)

Publication Date: January 1, 2019
Last Updated: March 14, 2022

Recommendations

CT acquisition prior to TAVI/TAVR

The imaging volume should include the aortic root, aortic arch and ilio-femoral access.

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Imaging of the aortic root should be performed using ECG-synchronized acquisition.

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Imaging of the aorta and iliofemoral vessels can be performed without ECG synchronization.

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Choice of acquisition mode should be tailored according to available scanner technology.

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CT acquisitions should focus on optimization of image quality while in accordance with ALARA principles.

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Thin slice collimation and reconstructed slice thickness ≤1 mm for the root and ≤1.5mm for the peripheral vasculature should be obtained and

used.

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In patients with an eGFR≥30mL/min/1.73 m2 no pre-hydration is required.

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In patients with eGFR<30mL/min/1.73 m2 reduction of iodinated contrast volume and prehydration may be considered.

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Routine use of beta blockade is not recommended.

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Beta blocker use may be considered in selected cases and should be used cautiously with careful clinical oversight.

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Use of nitroglycerin is contra-indicated.

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Sizing and reporting of the aortic valve, annulus and outflow tract

Annulus assessment and planning

While facilitated or semi-automated workflows may be used, the interpreter analyzing the imaging must be able to confirm the accuracy of the generated annular plane and perform manual corrections if required.

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Systolic measurements are preferred for measurement and calculation of device sizing.

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Area and perimeter measurements are preferred for sizing of the aortic annulus over isolated 2 dimensional measurements and should be provided in the report.

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Landing zone calcification

Annular and subannular calcification should be qualitatively described regarding morphology and extent as well as relation to the aortic valve cusps.

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Valve Morphology

Number of cusps should be stated, and if a bicuspid valve is present, its morphology should be classified.

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The presence of a median raphe and the absence/presence of calcification of this should be mentioned.

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The aortic annulus size should be measured and reported in bicuspid aortic valves as for tricuspid aortic valves.

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Aortic root measurement

Pre-TAVI/TAVR CT assessement should include coronary height, mean SOV diameter, and STJ height and diameter.

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Coronary ostial distance from aortic annulus should be measured in a perpendicular fashion from the established annular plane.

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Reporting of fluoroscopic angulation

Fluoroscopic planning

Provision of optimal fluoroscopic projection angulations based on CT for each individual patient should be considered.

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If the patient is not positioned supine for the CT examination, this should be noted in the report and proposed fluoroscopic angles should not be provided.

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Reporting of vascular access, coronary artery, and non-cardiac, non-vascular findings

Vascular access

While facilitated or semi-automated work-flows may be used, the interpreter analyzing the imaging must be able to confirm the accuracy of the generated vessel centerline and perform manual corrections if required.

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The minimal luminal diameter along both the right and left iliofemoral system should be provided including the anatomical location to the level of the expected puncture site.

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All areas of >270° calcification in the iliofemoral arteries should be reported.

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Calcification located anteriorly at the site of probable puncture should be reported.

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The report should include a clear description of all vascular pathologies including aneurysms, dissection, and occlusions.

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Coronary Arteries

Reporting of the coronary arteries for severity of coronary artery disease can be considered in appropriately selected patients, if image quality is of diagnostic quality.

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The presence and course of anomalous coronary arteries should be reported.

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Non-cardiac, non-vascular

CT images should be reviewed for incidental findings.

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Extracardiac findings should be reviewed and reported in the context of the healthcare environment and health status of the patient.

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Significant findings should be included in the dictated report and when appropriate verbally communicated to the Heart team.

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Reporting of post TAVI/TAVR and pre-VIV scans

Post TAVR

At present, routine CT imaging following TAVI/TAVR is not recommended.

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CT should be considered in the setting of clinical concern for valve thrombosis, infective endocarditis, or structural valve degeneration.

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Leaflet thickening should be described based on location, extent in length and overall thickness.

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Restricted motion should be reported as present or absent.

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Valve-in-valve

When available the size of the surgical valve in situ should be obtained from the patient records. When this is not possible, internal diameter may be measured and used for calculating the valve to be inserted.

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The relationship of the uppermost aspect of the surgical valve struts to the STJ and to the coronaries should be described.

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When the surgical valve struts end below the level of the coronary ostia, virtual transcatheter valve to coronary ostia distances do not need to be measured.

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Stentless surgical valve in valve procedures should be interpreted and reported as for native TAVI/TAVR cases regarding risk of coronary occlusion.

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Recommendation Grading

Overview

Title

Computed Tomography Imaging In The Context Of Transcatheter Aortic Valve Implantation (TAVI) / Transcatheter Aortic Valve Replacement (TAVR)

Authoring Organization

Society of Cardiovascular Computed Tomography

Publication Month/Year

January 1, 2019

Last Updated Month/Year

January 29, 2024

Supplemental Implementation Tools

Document Type

Consensus

External Publication Status

Published

Country of Publication

US

Document Objectives

It updates on the first expert consensus document on computed tomography imaging before transcatheter aortic valve implantation (TAVI)/transcatheter aortic valve replacement (TAVR) by the Society of Cardiovascular Computed Tomography (SCCT) in 2012.

Target Patient Population

Patients requires Transcatheter aortic valve implantation/replacement

Inclusion Criteria

Female, Male, Adolescent, Adult, Older adult

Health Care Settings

Ambulatory, Hospital, Outpatient, Radiology services

Intended Users

Nurse, nurse practitioner, physician, physician assistant

Scope

Assessment and screening, Diagnosis, Management

Diseases/Conditions (MeSH)

D001021 - Aortic Valve, D065467 - Transcatheter Aortic Valve Replacement, D014057 - Tomography, X-Ray Computed

Keywords

transcatheter aortic valve replacement (TAVR), computed tomographic imaging (CT), Transaortic valve replacement