Aortic stenosis, currently the most prevalent valvular heart disease in Europe, is an important public health problem, affecting thousands of patients every year. While surgical
aortic valve replacement is still considered the “gold standard” treatment, recent innovations in transcatheter valve therapies have offered an attractive alternative: transcatheter
aortic valve implantation (TAVI). In 2002, Cribier et al. announced the first human case description of a percutaneously implanted heart valve in a patient suffering from severe aortic
stenosis. Since then, the number of patients that undergo TAVI has increased exponentially.
Preliminary early and midterm results following TAVI have been promising. However, despite satisfactory hemodynamic results, TAVI procedures still face important
safety issues such as paravalvular leaks, vascular complications, stroke, conduction disorders
and the need for pacemaker implantation. Currently, TAVI is offered only to patients who are considered high risk candidates for surgical aortic valve replacement.
A fundamental characteristic of percutaneous interventions is the lack of direct visualization
of the target organ/tissue. Consequently, interventional cardiology is greatly related
to and depending on imaging. Especially in TAVI, which is entering the field of traditional
valve surgery, the role of multimodality cardiac imaging is mandatory. Contrast aortography, multi slice computed tomography (MSCT), magnetic resonance imaging and echocardiography can provide a detailed characterisation of vascular anatomy, aortic root dimensions, aortic valve calcifications and left ventricular (LV) function. The use of these imaging techniques is invaluable for patient selection and planning of the procedure. In addition, some techniques can be used during the operation to guide the implantation, as well as after the procedure to evaluate the positioning and function of the prosthesis.
TAVI is a fascinating technology but it is still in its infancy. Further studies are needed
in order to understand and modulate TAVI. The aim of the present thesis is to investigate
the role of advanced cardiac imaging for TAVI
