Industry group releases new guidelines for CT use in TAVR procedures

The Society of Cardiovascular Computed Tomography (SCCT) released updated guidelines for using CT imaging in patients undergoing transcatheter aortic valve replacement (TAVR).

Published Jan. 9 in the Journal of Cardiovascular Computed Tomography, the 2019 consensus document incorporates advances in CT angiography as well as new data collected since the previous guidelines were published in 2012.

“The 2019 consensus statement represents a contemporary assessment of the role of computed tomography (CT) imaging that will serve as important guidance to a field that has seen rapid growth over the last six years,” said author Jonathon A. Leipsic, MD, of the University of British Columbia, Vancouver, British Columbia, Canada, in a news release. “This guidance will in turn help ensure the appropriate use of CT to help inform clinical practice and continue to drive improvements in clinical outcomes for the patients we serve.”

Written by 11 experts, the recommendations have expanded optional non-surgical transcatheter aortic valve implantation (TAVI)/TAVR from patients ineligible for surgery or deemed high-risk to include patients who are at an intermediate risk for conventional surgical valve replacement.

The document provided a number of other guidelines, including new recommendations for CT acquisition prior to TAVI/TAVR. While protocols depend on many factors including the scanner itself, the “key” component for every approach is an electrocardiogram (ECG)-synchronized CTA data set that covers “at least the aortic root followed by a commonly non-ECG synchronized CTA data acquisition of the aorto/ilio/femoral vasculature for assessment of the access vasculature,” the authors wrote.

The group addressed four additional areas related to TAVI/TAVR. They are:

  • Understanding the sizing and reporting of the aortic valve, annulus and outflow tract.
  • Reporting on fluoroscopic angulation.
  • Guidance for reporting vascular access, coronary artery and non-cardiac, non-vascular findings.
  • Reporting post-TAVI-TAVR and pre-VIV scans.

Read the complete recommendations here.