Department of Radiology and Radiological Science, Division of Cardiology, Medical University of South Carolina, Charleston, SC 29401, USA.
J Thorac Imaging. 2013 Jul;28(4):231-9. doi: 10.1097/RTI.0b013e318292040c.
Transcatheter aortic valve replacement (TAVR) is rapidly becoming a widely used alternative to surgical aortic valve replacement (SAVR) in patients with severe aortic stenosis at high surgical risk. In these patients, TAVR has been associated with markedly improved survival and relief from symptoms. Despite a very-high risk patient profile, recent multicenter registries have confirmed the safety and efficacy of this procedure. Moreover, the randomized, controlled PARTNER (Placement of AoRTic TraNscathetER Valves) trial has confirmed both the superiority of TAVR over medical treatment in patients not considered to be candidates for standard SAVR and the noninferiority of TAVR compared with SAVR in high-risk patients. The TAVR procedure requires a comprehensive preinterventional diagnostic workup. Above all, detailed information on the anatomy of the aortic annulus (AA) and the relation of the AA to the coronary arteries is essential to avoid complications. So far, no imaging reference standard for AA sizing has been established. Echocardiography, catheter angiography, and computed tomography angiography are widely and often complementarily used imaging techniques for this purpose. Compared with 2-dimensional imaging techniques, computed tomography (CT) has been proven to provide comprehensive information on AA anatomy and geometry, supporting appropriate patient selection and prosthesis sizing. In addition, CT is gaining an increasing role in evaluating the vascular access route before the procedure. This article describes the rapidly emerging role of CT in the context of pre-TAVR assessment.
经导管主动脉瓣置换术（TAVR）在高手术风险的严重主动脉瓣狭窄患者中迅速成为外科主动脉瓣置换术（SAVR）的替代方法。在这些患者中，TAVR 与显著提高的生存率和症状缓解相关。尽管患者的风险非常高，但最近的多中心注册研究证实了该手术的安全性和有效性。此外，随机对照 PARTNER（经导管主动脉瓣置换术的放置）试验证实，在不被认为是标准 SAVR 候选者的患者中，TAVR 优于药物治疗，并且在高危患者中，TAVR 与 SAVR 相比具有非劣效性。TAVR 手术需要进行全面的术前诊断评估。最重要的是，需要详细了解主动脉瓣环（AA）的解剖结构以及 AA 与冠状动脉之间的关系，以避免并发症。到目前为止，尚未建立 AA 尺寸测量的成像参考标准。超声心动图、导管血管造影和计算机断层血管造影是广泛使用且经常互补的成像技术。与二维成像技术相比，CT 已被证明可提供有关 AA 解剖结构和几何形状的全面信息，支持适当的患者选择和假体尺寸。此外，CT 在术前评估血管入路方面的作用越来越大。本文描述了 CT 在 TAVR 评估背景下的快速发展作用。
