In the Journals

Updated guidelines ‘better reflect’ role of CT image acquisition for TAVR

The Society of Cardiovascular Computed Tomography recently issued updated guidelines for the use of CT imaging in the setting of transcatheter aortic valve replacement.

The update was issued because TAVR has rapidly become the preferred treatment for patients with symptomatic severe aortic stenosis with intermediate or high surgical risk, according to the society’s consensus statement.

“Advances in noninvasive imaging have supported growth and maturation of the field. Clinical outcomes have improved based on the thoughtful integration of advanced noninvasive imaging into patient selection, treatment planning, device selection and device positioning,” according to the statement.

Moreover, the authors noted that the role of CT has become the gold standard for annular sizing, determination of risk for annular injury and coronary occlusion and to provide co-planar fluoroscopic angle prediction in advance of the procedure.

“This updated consensus statement has been written to better reflect the data now available,” the authors wrote.

Notable updates

The expert consensus document focuses on several important areas.

First, the statement addresses the importance of reliable CT image acquisition for TAVR planning. For example, one new recommendation is that imaging volume include the aortic root, aortic arch and iliofemoral access and that ECG-synchronized acquisition should be used for imaging of the aortic root, among other recommendations.

Second, the document sets guidelines for sizing and reporting of the aortic valve, annulus and outflow tract, including guidance for annulus assessment and planning, landing zone calcification, valve morphology and aortic root measurement.

Third, the writing committee recommends considering provision of optimal fluoroscopic projection angulations for each individual and that physicians should note whether the patient is positioned supine for the CT examination and provide proposed fluoroscopic angles.

Fourth, the update includes recommendations on the reporting of vascular access, coronary artery and noncardiac, nonvascular findings.

Fifth, the statement offers recommendations on the reporting of post-TAVR and pre-valve-in-valve scans.

I mportant role of CT

“CT imaging plays an important role in procedural planning for TAVI/TAVR and should be a fully integrated component of any TAVI/ TAVR program. The use of CT in TAVI/TAVR is multifaceted and should include appropriate image acquisition and reconstruction as well as the comprehensive assessment the aortic root and vascular access,” the authors wrote. “Importantly, the individuals responsible for the interpretation of the CT examination should be part of the heart team to ensure appropriate incorporation of the data from the CTA into the patient selection process and procedure planning.” – by Melissa Foster

Disclosures: Blanke reports he is a consultant for Circle Cardiovascular Imaging and Edwards Lifesciences, and provides CT core lab services for Edwards Lifesciences, Medtronic, Neovasc and Tendyne Holdings, for which he receives no direct compensation. Please see the consensus statement for all other authors’ relevant financial disclosures.

The Society of Cardiovascular Computed Tomography recently issued updated guidelines for the use of CT imaging in the setting of transcatheter aortic valve replacement.

The update was issued because TAVR has rapidly become the preferred treatment for patients with symptomatic severe aortic stenosis with intermediate or high surgical risk, according to the society’s consensus statement.

“Advances in noninvasive imaging have supported growth and maturation of the field. Clinical outcomes have improved based on the thoughtful integration of advanced noninvasive imaging into patient selection, treatment planning, device selection and device positioning,” according to the statement.

Moreover, the authors noted that the role of CT has become the gold standard for annular sizing, determination of risk for annular injury and coronary occlusion and to provide co-planar fluoroscopic angle prediction in advance of the procedure.

“This updated consensus statement has been written to better reflect the data now available,” the authors wrote.

Notable updates

The expert consensus document focuses on several important areas.

First, the statement addresses the importance of reliable CT image acquisition for TAVR planning. For example, one new recommendation is that imaging volume include the aortic root, aortic arch and iliofemoral access and that ECG-synchronized acquisition should be used for imaging of the aortic root, among other recommendations.

Second, the document sets guidelines for sizing and reporting of the aortic valve, annulus and outflow tract, including guidance for annulus assessment and planning, landing zone calcification, valve morphology and aortic root measurement.

Third, the writing committee recommends considering provision of optimal fluoroscopic projection angulations for each individual and that physicians should note whether the patient is positioned supine for the CT examination and provide proposed fluoroscopic angles.

Fourth, the update includes recommendations on the reporting of vascular access, coronary artery and noncardiac, nonvascular findings.

Fifth, the statement offers recommendations on the reporting of post-TAVR and pre-valve-in-valve scans.

I mportant role of CT

“CT imaging plays an important role in procedural planning for TAVI/TAVR and should be a fully integrated component of any TAVI/ TAVR program. The use of CT in TAVI/TAVR is multifaceted and should include appropriate image acquisition and reconstruction as well as the comprehensive assessment the aortic root and vascular access,” the authors wrote. “Importantly, the individuals responsible for the interpretation of the CT examination should be part of the heart team to ensure appropriate incorporation of the data from the CTA into the patient selection process and procedure planning.” – by Melissa Foster

Disclosures: Blanke reports he is a consultant for Circle Cardiovascular Imaging and Edwards Lifesciences, and provides CT core lab services for Edwards Lifesciences, Medtronic, Neovasc and Tendyne Holdings, for which he receives no direct compensation. Please see the consensus statement for all other authors’ relevant financial disclosures.