Patient selection for transcatheter aortic valve replacement: A combined clinical and multimodality imaging approach

Table 1 Contraindications for transcatheter aortic valve implantation

Absolute contraindications

Absence of heart team or surgery on the site

Estimated life expectancy < 1 yr

Improvement of quality of life by TAVI unlikely because of comorbidities

Severe primary associated disease of other valves with major contribution to the patient’s symptoms, that can be treated only by surgery

Inadequate annulus size (< 18 mm, > 29 mm)

Thrombus in the left ventricle

Active endocarditis

Elevated risk of coronary ostium obstruction (asymmetric valve calcification, short distance between annulus and coronary ostium, small aortic sinuses)

Plaques with mobile thrombi in the ascending aorta, or arch

For transfemoral/subclavian approach: inadequate vascular access (vessel size, calcification, tortuosity)

Relative contraindications

Bicuspid or non-calcified valves

Untreated coronary artery disease requiring revascularization

Haemodynamic instability

LVEF < 20%

For transapical approach: severe pulmonary disease, LV apex not accessible

TAVI: Transcatheter aortic valve implantation; LVEF: Left ventricular EF.