Tag Archives: TAVR

Echocardiography Plays Vital Role in Planning, Execution and Follow-up of Transcatheter Aortic Valve Replacement

Current guidelines recommend a multidisciplinary approach as optimal for treating patients who qualify for transcatheter aortic valve replacement (TAVR).1 In addition to a care team of cardiac surgeons and interventional cardiologists, echocardiographers are involved in every phase of transcatheter valve replacement: from pre-implantation patient screening and selecting an appropriate valve size, to intraprocedural guidance of wire and valve position and post-implantation assessment.1

At Penn State Hershey Heart and Vascular Institute, patients first receive a transthoracic echocardiogram (TTE) to examine the aortic valve and quantify the degree of stenosis. Based on the combination of those results and other factors, high-risk patients who are not surgical candidates (due to multiple comorbidities) are referred for TAVR. “Further preparation involves several additional studies including a transesophageal echocardiogram (TEE) with three-dimensional (3D) imaging of the aortic root. This allows physicians to measure the aortic annulus and determine the appropriate size for the replacement valve,” says Michael Pfeiffer, M.D., Penn State Hershey Heart and Vascular Institute. TEE with 3D imaging also examines other aspects of the heart that may impact the TAVR procedure, such as the morphology of the left ventricular outflow track and aortic root, co-existing mitral valve disease and coronary artery position. Patients also receive multi-detector computed tomography (MDCT) evaluation as part of their pre-procedure assessment. Both imaging techniques are complementary pieces of the complete pre-implantation assessment. Continue reading

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Transcatheter Aortic Valve Replacement (TAVR) Expands Options for Inoperable Severe Aortic Stenosis Patients

Surgical aortic valve replacement is extremely low-risk for most patients. However, a significant number of patients are at high-risk for surgical valve replacement or are ineligible for surgery because of comorbidities. The less invasive TAVR procedure allows a new valve to be inserted within the native, diseased aortic valve, and can be performed utilizing multiple approaches (e.g., transfemoral, transapical, or transaortic).¹

Penn State Hershey Heart and Vascular Institute is unusual in its balanced case mix, according to chief of cardiac surgery, Walter E. Pae, Jr., M.D., “Our practice is fairly evenly divided among congenital pediatric heart defects, adult coronary disorders, and adult cardiac valve abnormalities. We perform up to 100 aortic valve replacements per year.” Interventional cardiologist Mark Kozak, M.D., concurs, noting that coronary disease is the focus of many institutions, due to its far greater frequency. Continue reading

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