The role of advanced imaging in transcatheter aortic valve implantation

Aortic stenosis, currently the most prevalent valvular heart disease in Europe, is an important public health problem, affecting thousands of patients every year. While surgical aortic valve replacement is still considered the “gold standard” treatment, recent innovations in transcatheter valve therapies have offered an attractive alternative: transcatheter aortic valve implantation (TAVI). In 2002, Cribier et al. announced the first human case description of a percutaneously implanted heart valve in a patient suffering from severe aortic stenosis. Since then, the number of patients that undergo TAVI has increased exponentially. Preliminary early and midterm results following TAVI have been promising. However, despite satisfactory hemodynamic results, TAVI procedures still face important safety issues such as paravalvular leaks, vascular complications, stroke, conduction disorders and the need for pacemaker implantation. Currently, TAVI is offered only to patients who are considered high risk candidates for surgical aortic valve replacement. A fundamental characteristic of percutaneous interventions is the lack of direct visualization of the target organ/tissue. Consequently, interventional cardiology is greatly related to and depending on imaging. Especially in TAVI, which is entering the field of traditional valve surgery, the role of multimodality cardiac imaging is mandatory. Contrast aortography, multi slice computed tomography (MSCT), magnetic resonance imaging and echocardiography can provide a detailed characterisation of vascular anatomy, aortic root dimensions, aortic valve calcifications and left ventricular (LV) function. The use of these imaging techniques is invaluable for patient selection and planning of the procedure. In addition, some techniques can be used during the operation to guide the implantation, as well as after the procedure to evaluate the positioning and function of the prosthesis. TAVI is a fascinating technology but it is still in its infancy. Further studies are needed in order to understand and modulate TAVI. The aim of the present thesis is to investigate the role of advanced cardiac imaging for TAVI.

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