Planning the Procedure

This chapter is dedicated to the preoperative multimodality imaging necessary for a thorough surgical or interventional aortic planning. From the point of view of surgical aortic valve replacement, the main factors to be taken into account are covered, such as the determination of the size of the aortic valve ring, the functional anatomy of the aortic root, the vascular axis and how to quantify calcifications. In case of surgical reintervention or minimally invasive access (ministernotomy, thoracotomy), the best imaging techniques (in particular CTA) to be adopted for planning and which anatomical landmarks to be given attention in the analysis are discussed. TAVI planning is mainly based on CTA analysis, for the choice of the best aortic prosthesis. Particular focus is given to the examination of the vascular accesses for the procedure, in particular femoral, subclavian, transapical and transaortic. The usefulness of imaging modalities complementary to CTA (e.g. echo, angiography) is illustrated, with attention to preventing complications of the procedure (paravalvular leakage and aortic ring rupture). In conclusion, which imaging tests are best indicated for the planning of TAVI associated procedures, such as the left atrial appendage closure or mitral interventions, are covered.