Review
Copyright ©The Author(s) 2017. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Cardiol. Mar 26, 2017; 9(3): 212-229
Published online Mar 26, 2017. doi: 10.4330/wjc.v9.i3.212
Patient selection for transcatheter aortic valve replacement: A combined clinical and multimodality imaging approach
Rosangela Cocchia, Antonello D’Andrea, Marianna Conte, Massimo Cavallaro, Lucia Riegler, Rodolfo Citro, Cesare Sirignano, Massimo Imbriaco, Maurizio Cappelli, Giovanni Gregorio, Raffaele Calabrò, Eduardo Bossone
Rosangela Cocchia, Rodolfo Citro, Eduardo Bossone, Department of Cardiology and Cardiac Surgery, San Giovanni di Dio Hospital, 00733 Salern, Italy
Antonello D’Andrea, Marianna Conte, Massimo Cavallaro, Lucia Riegler, Maurizio Cappelli, Raffaele Calabrò, Integrated Diagnostic Cardiology, Second University of Naples, AORN ¡°dei Colli¡±, Monaldi Hospital, 80121 Naples, Italy
Cesare Sirignano, Institute of Biostructure and Bioimaging National Research Council, 80121 Naples, Italy
Massimo Imbriaco, Department of Advanced Biomedical Sciences, University Federico II, 80121 Naples, Italy
Giovanni Gregorio, Department of Cardiology, San Luca Hospital, Vallo della Lucania, 00733 Salern, Italy
Author contributions: Cocchia R and D’Andrea A designed the research and wrote the paper; Conte M, Cavallaro M and Riegler L wrote the paper; Citro R and Cappelli M performed the research; Sirignano C reviewed and approved the research; Imbriaco M, Calabrò R and Bossone E reviewed the paper.
Conflict-of-interest statement: The authors report no relevant conflicts of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Antonello D’Andrea, MD, PhD, Integrated Diagnostic Cardiology, Second University of Naples, AORN ¡°dei Colli¡±, Monaldi Hospital, Corso Vittorio Emanuele 121A, 80121 Naples, Italy. antonellodandrea@libero.it
Telephone: +39-81-7062355 Fax: +39-81-7064234
Received: October 27, 2016
Peer-review started: October 31, 2016
First decision: December 1, 2016
Revised: December 15, 2016
Accepted: January 11, 2017
Article in press: January 14, 2017
Published online: March 26, 2017
Processing time: 150 Days and 3.3 Hours
Abstract

Transcatheter aortic valve replacement (TAVR) has been validated as a new therapy for patients affected by severe symptomatic aortic stenosis who are not eligible for surgical intervention because of major contraindication or high operative risk. Patient selection for TAVR should be based not only on accurate assessment of aortic stenosis morphology, but also on several clinical and functional data. Multi-Imaging modalities should be preferred for assessing the anatomy and the dimensions of the aortic valve and annulus before TAVR. Ultrasounds represent the first line tool in evaluation of this patients giving detailed anatomic description of aortic valve complex and allowing estimating with enough reliability the hemodynamic entity of valvular stenosis. Angiography should be used to assess coronary involvement and plan a revascularization strategy before the implant. Multislice computed tomography play a central role as it can give anatomical details in order to choice the best fitting prosthesis, evaluate the morphology of the access path and detect other relevant comorbidities. Cardiovascular magnetic resonance and positron emission tomography are emergent modality helpful in aortic stenosis evaluation. The aim of this review is to give an overview on TAVR clinical and technical aspects essential for adequate selection.

Keywords: Aortic stenosis; Doppler echocardiography; Cardiac computed tomography; Two-dimensional strain; Three dimensional echocardiography; Cardiac magnetic resonance; Transcatheter aortic valve replacement

Core tip: Transcatheter aortic valve replacement (TAVR) has been validated as a new therapy for patients affected by severe symptomatic aortic stenosis who are not eligible for surgical intervention because of major contraindication or high operative risk. Patient selection for TAVR should be based not only on accurate assessment of aortic stenosis morphology, but also on several clinical and functional data. Multi-Imaging modalities are preferred for assessing the anatomy and the dimensions of the aortic valve and annulus before TAVR. The aim of this review is to give an overview on TAVR clinical and technical aspects essential for adequate selection.