Sandbox:tavr
Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Seyedmahdi Pahlavani, M.D. [2]
Transcatheter Aortic Valve Replacement (TAVR) Procedure Guide Microchapters |
---|
Overview |
Definition |
Risk Assessment |
Diagnosis |
Treatment |
Do's |
Don'ts |
Overview
During the past 50 years, surgical aortic valve replacement (SAVR) was the standard of care for patients with severe AS. Global aging has raised concerns about safety and possibility of surgical procedure in old patients with associated co-morbidities. Transcatheter aortic valve replacement (TAVR) created a new era of safety for this population and enabled physicians to replace the stenotic valve with more certainty.
Preoperation evaluation, selecting the appropriate imaging modality, issues in TAVR procedure and patient follow up are the areas of more focused importance.
We will describe these factors based on the recent expert consensus for TAVR procedure.
Definition
The most important step is to define the severity of AS and appropriate patient that need TAVR. Severe sypmtomatic (Stage D) AS is considered as TAVR candidate.
Severe symptomatic AS (stage D) | |||||
---|---|---|---|---|---|
STAGE | DEFINITION | SYMPTOMS | VALVE ANATOMY | VALVE HEMODYNAMICS | HEMODYNAMIC CONSEQUENCES |
D1 | Symptomatic severe high-gradient AS | Severe calcification or congenital stenosis with severely reduced opening |
| ||
D2 | Symptomatic severe low-flow/low gradient AS with reduced LVEF |
|
Severe calcification or congenital stenosis with severely reduced leaflet motion |
|
|
D3 | Symptomatic severe low gradient with normal LVEF |
|
Severe calcification with severely reduced leaflet motion |
|
|
TAVR Pathway outline
Abbreviations: CV: Cardiovascular, AVR: aortic valve replacement, AS: aortic stenosis
Care Providing Team
|
Clinical Evaluation
|
Cardio-vascular Imaging
{{Familytree|boxstyle=background: #FFF0F5; color: #000000;width: 400px; text-align: left; font-size: 90%; padding: 0px;| | | A01 | |A01= Pre TAVR
{{Familytree|boxstyle=background: #FFF0F5; color: #000000;width: 400px; text-align: left; font-size: 90%; padding: 0px;| | | B01 | |B01=
Echo
Risk AssessmentUnderlying risk for SAVR is basic component to consider patient for TAVR. This risk assessment is based on several components that include:
‡ Examples of major organ system compromise:
¶ Examples: tracheostomy present, heavily calcified ascending aorta, chest malformation, arterial coronary graft adherent to posterior chest wall, or radiation damage.
Heart Valve TeamPatients with severe AS should be evaluated by a multidisciplinary Heart Valve Team when intervention is considered. |