title: Practical considerations for optimizing cardiac computed tomography protocols for comprehensive acquisition prior to transcatheter aortic valve replacement.
abstract: Transcatheter aortic valve replacement (TAVR) is performed frequently in patients with severe, symptomatic aortic stenosis who are at high risk or inoperable for open surgical aortic valve replacement. Computed tomography angiography (CTA) has become the gold standard imaging modality for pre-TAVR cardiac anatomic and vascular access assessment. Traditionally, cardiac CTA has been most frequently used for assessment of coronary artery stenosis, and scanning protocols have generally been tailored for this purpose. Pre-TAVR CTA has different goals than coronary CTA and the high prevalence of chronic kidney disease in the TAVR patient population creates a particular need to optimize protocols for a reduction in iodinated contrast volume. This document reviews details which allow the physician to tailor CTA examinations to maximize image quality and minimize harm, while factoring in multiple patient and scanner variables which must be considered in customizing a pre-TAVR protocol.
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA. Electronic address: ok2203@cumc.columbia.edu.
authors.forename: Omar K
authors.initials: OK
authors.lastname: Khalique
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Todd C
authors.initials: TC
authors.lastname: Pulerwitz
authors.affiliation: Philips Healthcare, Cleveland, OH, USA.
authors.forename: Sandra S
authors.initials: SS
authors.lastname: Halliburton
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Susheel K
authors.initials: SK
authors.lastname: Kodali
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Rebecca T
authors.initials: RT
authors.lastname: Hahn
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Tamim M
authors.initials: TM
authors.lastname: Nazif
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Torsten P
authors.initials: TP
authors.lastname: Vahl
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Isaac
authors.initials: I
authors.lastname: George
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Martin B
authors.initials: MB
authors.lastname: Leon
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Belinda
authors.initials: B
authors.lastname: D'Souza
authors.affiliation: Columbia University Medical Center/New York Presbyterian Hospital, New York, NY, USA.
authors.forename: Andrew J
authors.initials: AJ
authors.lastname: Einstein
mesh_terms: D001021:Aortic Valve / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods; D055424:Cardiac-Gated Imaging Techniques; D000072226:Computed Tomography Angiography / Q000009:adverse effects / Q000295:instrumentation; D003287:Contrast Media / Q000008:administration & dosage; D017023:Coronary Angiography / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D004562:Electrocardiography; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods; D006801:Humans; D011237:Predictive Value of Tests; D011829:Radiation Dosage; D000069079:Radiation Exposure / Q000009:adverse effects / Q000517:prevention & control; D011857:Radiographic Image Interpretation, Computer-Assisted; D015203:Reproducibility of Results; D012307:Risk Factors; D012720:Severity of Illness Index; D015898:Tomography Scanners, X-Ray Computed
chemical_list: D003287:Contrast Media
keywords: Aortic stenosis; CT acquisition; TAVR