Tailoring TAVI in Asia: insights from MSCT

Stephen A. O’Connor, Nicolo Piazza, Darren Mylotte

Clinical outcomes from transcatheter aortic valve implantation (TAVI) have improved remarkably over the last decade and have the potential to surpass those associated with surgical aortic valve replacement (SAVR)1,2. Such success can be attributed to a number of key advances, including physician experience, device iteration, and patient selection. The latter infers choosing the most appropriate patient for the procedure and, more importantly, assumes the application of the optimal procedural strategy for each case. In this regard, the introduction of three-dimensional (3D) multislice computed tomography (MSCT) for transcatheter heart valve (THV) sizing and procedural planning has been revolutionary.

THV sizing with 2D transoesophageal echocardiography is suboptimal. This strategy increases the rates of significant paravalvular leak, post-implantation balloon dilatation, and yields longer and more complex procedures3. It has been suggested that 3D transoesophageal echocardiography can provide similar annular measurements to MSCT; however, our group’s experience with this technique has been disappointing4. Moreover, MSCT provides much more than THV sizing alone. A good quality CT data set can determine the most appropriate vascular access route, provide crucial information on coronary height, sinotubular junction and sinus of Valsalva width, aortic root angulation, and implant plane. These elements impact on the selection of the type and size of the transcatheter prosthesis..