Combined CT Coronary Artery Assessment and TAVI Planning
Computed tomography angiography (CTA) of the aorta and the iliofemoral arteries is crucial for preprocedural planning of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS), because it provides details on a variety of aspects required for heart team decision-m...
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| Format: | Article |
| Language: | English |
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MDPI AG
2023-04-01
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| Series: | Diagnostics |
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| Online Access: | https://www.mdpi.com/2075-4418/13/7/1327 |
| _version_ | 1827746933021605888 |
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| author | Matthias Renker U. Joseph Schoepf Won Keun Kim |
| author_facet | Matthias Renker U. Joseph Schoepf Won Keun Kim |
| author_sort | Matthias Renker |
| collection | DOAJ |
| description | Computed tomography angiography (CTA) of the aorta and the iliofemoral arteries is crucial for preprocedural planning of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS), because it provides details on a variety of aspects required for heart team decision-making. In addition to providing relevant diagnostic information on the degree of aortic valve calcification, CTA allows for a customized choice of the transcatheter heart valve system and the TAVI access route. Furthermore, current guidelines recommend the exclusion of relevant coronary artery disease (CAD) prior to TAVI. The feasibility of coronary artery assessment with CTA in patients scheduled for TAVI has been established previously, and accumulating data support its value. In addition, fractional flow reserve determined from CTA (CT–FFR) and machine learning-based CT–FFR were recently shown to improve its diagnostic yield for this purpose. However, the utilization of CTA for coronary artery evaluation remains limited in this specific population of patients due to the relatively high risk of CAD coexistence with severe AS. Therefore, the current diagnostic work-up prior to TAVI routinely includes invasive catheter coronary angiography at most centers. In this article, the authors address technological prerequisites and CT protocol considerations, discuss pitfalls, review the current literature regarding combined CTA coronary artery assessment and preprocedural TAVI evaluation, and provide an overview of unanswered questions and future research goals within the field. |
| first_indexed | 2024-03-11T05:40:12Z |
| format | Article |
| id | doaj.art-c70d48875e4f41d898c1d2c19d00300d |
| institution | Directory Open Access Journal |
| issn | 2075-4418 |
| language | English |
| last_indexed | 2024-03-11T05:40:12Z |
| publishDate | 2023-04-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Diagnostics |
| spelling | doaj.art-c70d48875e4f41d898c1d2c19d00300d2023-11-17T16:31:03ZengMDPI AGDiagnostics2075-44182023-04-01137132710.3390/diagnostics13071327Combined CT Coronary Artery Assessment and TAVI PlanningMatthias Renker0U. Joseph Schoepf1Won Keun Kim2Department of Cardiology, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, GermanyHeart & Vascular Center, Medical University of South Carolina, Charleston, SC 29425, USADepartment of Cardiology, Campus Kerckhoff of the Justus Liebig University Giessen, 61231 Bad Nauheim, GermanyComputed tomography angiography (CTA) of the aorta and the iliofemoral arteries is crucial for preprocedural planning of transcatheter aortic valve implantation (TAVI) in patients with severe aortic stenosis (AS), because it provides details on a variety of aspects required for heart team decision-making. In addition to providing relevant diagnostic information on the degree of aortic valve calcification, CTA allows for a customized choice of the transcatheter heart valve system and the TAVI access route. Furthermore, current guidelines recommend the exclusion of relevant coronary artery disease (CAD) prior to TAVI. The feasibility of coronary artery assessment with CTA in patients scheduled for TAVI has been established previously, and accumulating data support its value. In addition, fractional flow reserve determined from CTA (CT–FFR) and machine learning-based CT–FFR were recently shown to improve its diagnostic yield for this purpose. However, the utilization of CTA for coronary artery evaluation remains limited in this specific population of patients due to the relatively high risk of CAD coexistence with severe AS. Therefore, the current diagnostic work-up prior to TAVI routinely includes invasive catheter coronary angiography at most centers. In this article, the authors address technological prerequisites and CT protocol considerations, discuss pitfalls, review the current literature regarding combined CTA coronary artery assessment and preprocedural TAVI evaluation, and provide an overview of unanswered questions and future research goals within the field.https://www.mdpi.com/2075-4418/13/7/1327aortic stenosischronic coronary syndromecoronary artery diseasecomputed tomographyfractional flow reservetranscatheter aortic valve implantation |
| spellingShingle | Matthias Renker U. Joseph Schoepf Won Keun Kim Combined CT Coronary Artery Assessment and TAVI Planning Diagnostics aortic stenosis chronic coronary syndrome coronary artery disease computed tomography fractional flow reserve transcatheter aortic valve implantation |
| title | Combined CT Coronary Artery Assessment and TAVI Planning |
| title_full | Combined CT Coronary Artery Assessment and TAVI Planning |
| title_fullStr | Combined CT Coronary Artery Assessment and TAVI Planning |
| title_full_unstemmed | Combined CT Coronary Artery Assessment and TAVI Planning |
| title_short | Combined CT Coronary Artery Assessment and TAVI Planning |
| title_sort | combined ct coronary artery assessment and tavi planning |
| topic | aortic stenosis chronic coronary syndrome coronary artery disease computed tomography fractional flow reserve transcatheter aortic valve implantation |
| url | https://www.mdpi.com/2075-4418/13/7/1327 |
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