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Hostile anatomies—including large and small aortic annuli (SAA), severe calcification, and pronounced septal hypertrophy—pose unique challenges during transcatheter aortic valve implantation (TAVI). This chapter offers a structured, case-based approach to pre-procedural planning, prosthesis selection, and technical optimization in these complex scenarios. Strategies are detailed for managing oversized annuli, avoiding prosthesis–patient mismatch (PPM) in small anatomies, and mitigating risks associated with bulky calcifications such as paravalvular leak (PVL), annular rupture, and stroke. Specific attention is given to the assessment and treatment of pure aortic regurgitation (AR) and left ventricular outflow tract (LVOT) obstruction due to asymmetric septal hypertrophy (ASH). Tailored procedural adaptations—including valve type choice, depth of implantation, oversizing techniques, and bailout therapies like alcohol septal ablation (ASA)—are presented to enhance safety and procedural success. By integrating advanced imaging, anatomical insight, and contemporary device technology, this chapter provides interventionalists with practical tools to navigate high-risk anatomy with confidence.

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How to Manage Hostile Anatomies: Large and Small Annuli, Severely Calcific Anatomy, and Severe Left Ventricular Outflow Tract Hypertrophy

  • 章节

  • 发表日期：

    2026年

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  • Francesco Gallo,
  • Alessandra Laricchia,
  • Carolina Montonati,
  • Mariano Pellicano,
  • Alfonso Ielasi,
  • Giorgos Tzanis,
  • Francesco Giannini

摘要

Hostile anatomies—including large and small aortic annuli (SAA), severe calcification, and pronounced septal hypertrophy—pose unique challenges during transcatheter aortic valve implantation (TAVI). This chapter offers a structured, case-based approach to pre-procedural planning, prosthesis selection, and technical optimization in these complex scenarios. Strategies are detailed for managing oversized annuli, avoiding prosthesis–patient mismatch (PPM) in small anatomies, and mitigating risks associated with bulky calcifications such as paravalvular leak (PVL), annular rupture, and stroke. Specific attention is given to the assessment and treatment of pure aortic regurgitation (AR) and left ventricular outflow tract (LVOT) obstruction due to asymmetric septal hypertrophy (ASH). Tailored procedural adaptations—including valve type choice, depth of implantation, oversizing techniques, and bailout therapies like alcohol septal ablation (ASA)—are presented to enhance safety and procedural success. By integrating advanced imaging, anatomical insight, and contemporary device technology, this chapter provides interventionalists with practical tools to navigate high-risk anatomy with confidence.