Transcatheter Aortic Valve Replacement

Aortic stenosis (AS) is the second most common form of valvular heart disease in the western world with bicuspid aortic valve being the second most common congenital cardiac anomaly, after patent foramen ovale. Isolated aortic regurgitation (AR) is less common than symptomatic AS. Imaging plays a significant role in diagnosis, procedural planning and intraprocedural management in these patients. Management can be either conservative or include valve replacement with either transcatheter or surgical options for symptomatic patients with severe disease. This chapter explores the indications and important imaging features in diagnosis, pre-procedural planning and management. The heart team discussion highlights the multifactorial approach optimizing device choice, aortic root features, chosen access route and the prediction and prevention of complications as well as Food and Drug Administration approval of Transcatheter Aortic Valve Replacement (TAVR) in low-risk patients and Valve in Valve procedures. There is a resurgence in balloon valvuloplasty which is indicated as a bridge to more definitive TAVR and Surgical Aortic Valve Replacement (SAVR) and is now also increasingly utilised in valve orifice dilatation pre and post Transcatheter heart Valve (THV) deployment. Post procedural patient follow-up and imaging is discussed and is aimed at confirmation of procedural success as well as identification of procedural complications and guidance of further clinical decision making.