Medizinische Klinik 2, Uniklinikum Erlangen, Friedrich-Alexander-Universität Erlangen-Nürnberg, 91054, Erlangen, Germany.
Herz. 2023 Oct;48(5):359-365. doi: 10.1007/s00059-023-05203-4. Epub 2023 Aug 18.
Since its introduction in 2022, transcatheter aortic valve implantation (TAVI) has revolutionized the treatment and prognosis of patients with aortic stenosis. Robust clinical trial data and a wealth of scientific evidence support its efficacy and safety. One of the key factors for success of the TAVI procedure is careful preprocedural planning using imaging. Computed tomography (CT) has developed into the standard imaging method for comprehensive patient assessment in this context. Suitability of the femoral and iliac arteries for transfemoral access, exact measurement of aortic annulus size and geometry as the basis for prosthesis selection, quantification of the spatial relationship of the coronary ostia to the aortic annular plane, and identification of optimal fluoroscopic projection angles for the implantation procedure are among the most important information that can be gained from preprocedural CT. Further research is aimed at improving risk stratification, for example, with respect to annular perforation, periprosthetic aortic regurgitation, and need for postprocedural implantation of a permanent pacemaker.
自 2022 年问世以来，经导管主动脉瓣置换术（TAVI）彻底改变了主动脉瓣狭窄患者的治疗和预后。大量的临床试验数据和丰富的科学证据支持其疗效和安全性。TAVI 手术成功的关键因素之一是使用影像学进行仔细的术前规划。在这种情况下，计算机断层扫描（CT）已成为全面评估患者的标准影像学方法。股动脉和髂动脉是否适合经股动脉入路、主动脉瓣环大小和几何形状的精确测量作为假体选择的基础、冠状动脉口与主动脉瓣环平面之间空间关系的量化以及识别植入手术的最佳透视投影角度等，都是术前 CT 可以获得的最重要信息。进一步的研究旨在改善风险分层，例如，与瓣环穿孔、瓣周主动脉瓣反流和永久性起搏器植入的术后需求相关。
