TAVR (Transcatheter Aortic Valve Replacement)

Catheter-based replacement of the aortic valve in patients with severe aortic stenosis who are poor candidates for open surgical AVR. One of the largest changes in cardiovascular medicine over the past decade — TAVR has steadily expanded from high-risk to intermediate- and now low-risk indications.

Clinical workflow

Pre-procedure CT — contrast-enhanced ECG-gated cardiac CT measures aortic annulus, coronary heights, access vessels. Dedicated 64-slice-class CT essential; cardiac + peripheral runoff in one exam.
Access — transfemoral default; alternative access (TA, TAo, subclavian, carotid) less frequent.
Valve deployment — balloon-expandable (Edwards SAPIEN) or self-expanding (Medtronic Evolut) under fluoroscopic + TEE guidance.
Post-deployment assessment — paravalvular leak evaluation, hemodynamics, final angiography.

Typical imaging systems

Cardiac CT (pre-procedure): SOMATOM Definition Flash, Revolution Apex, Aquilion ONE — systems with reliable cardiac gating
Fluoroscopy (procedure): biplane cath lab or hybrid OR — Allura Biplane, Artis pheno, Azurion 7
TEE (procedure): Philips iE33, GE Vivid E9 with 3D TEE probe

Room requirements

Hybrid OR or biplane cath lab. Sterile OR-grade environment with full cath lab imaging capability. Perfusion team, anesthesiology, cardiothoracic backup, TEE, hemodynamics. Multi-disciplinary heart team evaluation before every case.

Procedure characteristics

Room time: 2–4 hours
Fluoroscopy time: 15–45 min (variable with complexity)
Length of stay: 1–3 days (most patients; same-day discharge selected cases)
Valve-in-valve: increasingly used for degenerated surgical valves

Imaging quality matters

Small annulus measurement errors (~1 mm) change valve sizing decisions. CT protocol standardization + reader experience affect outcomes. Procedural dose varies widely — complex cases can push regulatory limits.