To plan a transcatheter aortic valve implantation (TAVI) procedure using dedicated software, the following steps are usually followed:

Patient Data Collection

Before starting with the dedicated software, it is necessary to collect all relevant clinical data of the patient, including:

• Cardiac imaging: Cardio CT synchronized with the entire cardiac cycle (preferably with contrast).
• Clinical History:Anamnesis data, comorbidities, any previous cardiac interventions.

Image Upload to the Software

Upload the CT images into the planning software. This software can be Aycan, Osirix MD, 3Mensio, HeartNavigator, or other similar. However, these platforms must be CE or FDA-certified to guarantee the safety and quality standards required by current regulations.

Image Analysis

Use the software to perform a detailed analysis of the images. This step includes:

• Anatomical Structure Segmentation:: Identify relevant structures such as the aortic root, valve leaflets, aortic annulus, and coronary ostium.
• Precise Measurements:Diameter of the aortic annulus, size of the left ventricular outflow tract (LVOT),Aortic Root Assessment, Caliber and shape of the annulus, maximum diameter, minimum diameter, and area.
• Calcification Analysis:Location and amount of calcifications in the aortic valve and annulus.
• Distance from Coronary Ostia:Measure the distance between the annulus and the origin of the coronary arteries.

Simulation of the Intervention

Use the software to simulate the valve implantation:

• Valve Selection:Choose the type and size of the most suitable TAVI valve based on the measurements obtained.
• Implantation Simulation: Simulate the insertion and positioning of the valve to verify the suitability and absence of coronary obstructions.

Vascular Pathway Planning

• Vascular Access:Determine the best vascular access (femoral, subclavian, transapical, transaortic, etc.) by evaluating the diameter and tortuosity of the vessels using CT images.
• Pathway Simulation:Simulate the catheter path and calculate angles and tortuositiesuntil the desired position in the aortic annulus.

Review and Confirm

• Data Review:Always verify the patient code that corresponds to the analyzed CT; Always verify and share the measurements and simulations with the multidisciplinary team (cardiologists, cardiac surgeons, valvular surgeons).
• Final Decision: Share and Confirm the intervention plan

Final Considerations

Accurate and ISO9001 Certified planning is crucial for the success of a TAVI, reducing the risk of complications and improving patient outcomes. Teamwork and effective communication between all members of the interventional team is essential.

Computed Tomography Imaging in the Context of Transcatheter Aortic Valve Implantation (TAVI)/Transcatheter Aortic Valve Replacement (TAVR) An Expert Consensus Document of the Society of Cardiovascular Computed Tomography

Take notes on the journey…