title: Non-Valvular Findings before Trans-Catheter Aortic Valve Implantation and their Impact on the Procedure.
abstract: Background: Trans-cathetervalve implantation (TAVI) is a non- surgical alternative for patients with severe aortic stenosis (AS). Pre-procedural computed tomography angiography (CTA) allows accurate "road mapping," aortic annulus sizing and the detection of incidental findings.
  
  
  OBJECTIVE
  To document the prevalence of non-valvular extracardiac findings on CTA prior to TAVI and the impact of these findings on the procedure.
  
  
  METHODS
  Ninety AS patients underwent CTA as part of pre-TAVI planning. Scans extended from the clavicles to the groin. Non-vascular non-valvular findings were documented and graded as follows: (A) significant findings causing TAVI cancellation or postponement, (B) significant findings leading to a change in the TAVI procedure approach, (C) non-significant findings not affecting the TAVI procedure.
  
  
  RESULTS
  TAVI was planned for 90 patients; their average age was 80.2 ± 7.5 years, 53% were females. Overall, non-valvular cardiac, extracardiac and extravascular significant and non-significant incidental findings were documented in 97% of scans (87/90). Significant pathologies causing TAVI cancellation or postponement (category A) were documented in 8%. Significant findings affecting the TAVI procedure (category B) were found in 16% of patients.
  
  
  CONCLUSIONS
  Pre-TAVI CTA detected non-valvular extravascular pathologies leading to procedure cancellation/postponement or procedure modification in 8% and 16%, respectively. Comprehensive CTA evaluation that acknowledges the importance of such findings is of major importance since it might alter the TAVI procedure or even render it inappropriate.
authors.forename: Orly
authors.initials: O
authors.lastname: Goitein
authors.forename: Elio
authors.initials: E
authors.lastname: Di Segni
authors.forename: Yael
authors.initials: Y
authors.lastname: Eshet
authors.forename: Victor
authors.initials: V
authors.lastname: Guetta
authors.forename: Amit
authors.initials: A
authors.lastname: Segev
authors.forename: Eyal
authors.initials: E
authors.lastname: Nahum
authors.forename: Ehud
authors.initials: E
authors.lastname: Raanani
authors.forename: Eli
authors.initials: E
authors.lastname: Konen
authors.forename: Ashraf
authors.initials: A
authors.lastname: Hamdan
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001024:Aortic Valve Stenosis / Q000473:pathology / Q000601:surgery*; D017023:Coronary Angiography / Q000379:methods*; D005260:Female; D006801:Humans; D033162:Incidental Findings; D008297:Male; D011300:Preoperative Care / Q000379:methods; D012720:Severity of Illness Index; D014057:Tomography, X-Ray Computed / Q000379:methods*; D065467:Transcatheter Aortic Valve Replacement / Q000379:methods*