Non-Valvular Findings before Trans-Catheter Aortic Valve Implantation and their Impact on the Procedure

• Published in: The Israel Medical Association journal 2015-12, Vol.17 (12), p.764-767
• Main Authors: Goitein, Orly, Di Segni, Elio, Eshet, Yael, Guetta, Victor, Segev, Amit, Nahum, Eyal, Raanani, Ehud, Konen, Eli, Hamdan, Ashraf
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Aortic Valve Stenosis - pathology; Aortic Valve Stenosis - surgery; Coronary Angiography - methods; Female; Humans; Incidental Findings; Male; Preoperative Care - methods; Severity of Illness Index; Tomography, X-Ray Computed - methods; Transcatheter Aortic Valve Replacement - methods
• ISSN: 1565-1088

Background: Trans-cathetervalve implantation (TAVI) is a non- surgical alternative for patients with severe aortic stenosis (AS). Pre-procedural computed tomography angiography (CTA) allows accurate "road mapping," aortic annulus sizing and the detection of incidental findings. To document the prevalence of non-valvular extracardiac findings on CTA prior to TAVI and the impact of these findings on the procedure. Ninety AS patients underwent CTA as part of pre-TAVI planning. Scans extended from the clavicles to the groin. Non-vascular non-valvular findings were documented and graded as follows: (A) significant findings causing TAVI cancellation or postponement, (B) significant findings leading to a change in the TAVI procedure approach, (C) non-significant findings not affecting the TAVI procedure. TAVI was planned for 90 patients; their average age was 80.2 ± 7.5 years, 53% were females. Overall, non-valvular cardiac, extracardiac and extravascular significant and non-significant incidental findings were documented in 97% of scans (87/90). Significant pathologies causing TAVI cancellation or postponement (category A) were documented in 8%. Significant findings affecting the TAVI procedure (category B) were found in 16% of patients. Pre-TAVI CTA detected non-valvular extravascular pathologies leading to procedure cancellation/postponement or procedure modification in 8% and 16%, respectively. Comprehensive CTA evaluation that acknowledges the importance of such findings is of major importance since it might alter the TAVI procedure or even render it inappropriate.