Best Practices for Imaging of Transcatheter Valve Failure: An Update from the Heart Valve Collaboratory (JACC March 2025-1)-Article: Best Practices for Imaging of Transcatheter Valve Failure: An Update from the Heart Valve Collaboratory

Article: Best Practices for Imaging of Transcatheter Valve Failure: An Update from the Heart Valve Collaboratory

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The JACC State-of-the-Art Review provides an updated framework from the Heart Valve Collaboratory addressing the increasing concern of transcatheter valve failure (TVF) after transcatheter aortic valve replacement (TAVR). As the procedure is performed on increasingly younger patients, the focus has shifted to the long-term management of these cases, including options such as redo-TAVR or surgical TAV explantation. While current mid-to-long-term TAVR failure rates are relatively low, the growing number of procedures heralds an increase in TVF cases over time. <br /><br />The review emphasizes the necessity of standardized definitions and imaging protocols for diagnosing and managing TVF. Various imaging modalities such as echocardiography, cardiac computed tomography angiography (CCTA), cardiac magnetic resonance imaging (CMR), and positron emission tomography (PET) are discussed for their roles in evaluating TVF. The framework recommends systematic imaging workflows for post-TAVR follow-up, procedural planning for redo-TAV, and ongoing post–redo-TAV management to enhance patient outcomes in aortic valve disease management.<br /><br />A stepwise approach for diagnosing TVF involves multimodal imaging assessments focusing on nonstructural and structural bioprosthetic valve dysfunction (BVD), possible reversible structural BVDs like thrombosis and endocarditis, and suggestions for the updated practical application of the Heart Valve Collaboratory framework using these imaging techniques.<br /><br />The article further highlights the importance of comprehensive pre-procedural planning for redo-TAV procedures, advising detailed pre-index and post-index TAVR CT analyses. Utilizing applications like the Redo TAV app can assist with procedure-specific guides, along with helping assess coronary obstruction risks and ensuring optimal outcomes. The document stresses the need for precise imaging during follow-ups and recognizes ongoing registry data's role in improving understanding and decision-making related to TVF and redo-TAVR.

Keywords

transcatheter valve failure

TAVR

Heart Valve Collaboratory

redo-TAVR

surgical TAV explantation

imaging protocols

bioprosthetic valve dysfunction

multimodal imaging

pre-procedural planning

coronary obstruction risks