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North American Expert Review of Rotational Atherectomy Treating Bifurcation Lesions: The Result Overcomes the Technique Orbital atherectomy for the treatment of small (2.5mm) severely calcified coronary lesions: ORBIT II sub-analysis Pulmonary hypertension is associated with an increased incidence of NAFLD: A retrospective cohort study of 18,910 patients Pivotal trial to evaluate the safety and efficacy of the orbital atherectomy system in treating de novo, severely calcified coronary lesions (ORBIT II) Comparison of 2 Different Drug-Coated Balloons in In-Stent Restenosis: The RESTORE ISR China Randomized Trial Temporal changes in radial access use, associates and outcomes in patients undergoing PCI using rotational atherectomy between 2007 and 2014: results from the British Cardiovascular Intervention Society national database Right ventricular expression of NT-proBNP adds predictive value to REVEAL score in patients with pulmonary arterial hypertension Drug-Coated Balloon for De Novo Coronary Artery Disease: JACC State-of-the-Art Review Intravascular ultrasound enhances the safety of rotational atherectomy

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TAVR: Role of Multimodality Imaging

Pre-reading

The following are key points to remember from this state-of-the-art review on transcatheter aortic valve replacement (TAVR) and the role of multimodality imaging in common and complex clinical scenarios:

  1. 1. TAVR has rapidly become an established therapy for patients with symptomatic severe aortic stenosis (AS).
  2. 2. Technological advances and the learning curve have resulted in better procedural results in terms of hemodynamic valve performance and intermediate-term clinical outcomes.
  3. 3. The integration of anatomical and functional information provided by multimodality imaging has improved size selection of TAVR prostheses, permitted better patient selection, and provided new insights in the performance of the TAVR prostheses at follow-up.
  4. 4. The use of 3D imaging techniques (multi-detector row computed tomography [MDCT], cardiac magnetic resonance [CMR], and 3D echocardiography) that permit accurate measurement of the left ventricular outflow tract area by direct planimetry has demonstrated the ability to reclassify severe AS patients into moderate AS by 12% in patients with low-flow, low-gradient severe AS.
  5. 5. Furthermore, the field of TAVR continues to develop and expand the technique to younger patients with lower risk on the one hand, and more complex clinical scenarios, on the other hand, such as degenerated aortic bioprostheses, bicuspid aortic valves, or pure native aortic regurgitation.
  6. 6. The use of both echocardiography and MDCT is key in the diagnosis of patients with severe AS who may benefit from TAVR as well as in the procedural planning and evaluation of the results at follow-up.
  7. 7. The number of patients with bicuspid AS treated with TAVR is increasing and the TAVR results with the use of new generation prostheses are promising.
  8. 8. TAVR in degenerated bioprosthesis has been an important recent breakthrough because re-operation in these individuals is associated with very high mortality.
  9. 9. Patients with native aortic regurgitation are also now being treated with TAVR.
  10. 10. These newer indications for TAVR need careful imaging evaluation of the anatomy of the landing zone to ensure successful anchoring of the TAVR prosthesis and to minimize complications. These new horizons for TAVR are making multimodality imaging critically important for this evolving therapy.