Is a Low Dose Computed Tomography Angiography Protocol Feasible in Terms of Maintaining Adequate Diagnostic Image Quality for TAVR Candidates?

Abstract

https://e-jcvi.org Transcatheter aortic valve replacement (TAVR) has been initiated first for inoperable patients with severe aortic stenosis (AS) and prohibitive comorbidities, then in high-, intermediateand, more recently, low-risk patients. Nowadays, TAVR has been established as the firstline treatment method for symptomatic patients of any age with severe AS and a high or prohibitive surgical risk.1) Computed tomography angiography (CTA) allows pre-procedural comprehensive evaluation for TAVR including coronary artery, aortic valve, aortic root, entire aorta, and vascular access site suitability at the same time.2) Accordingly, large amount of contrast medium is mandatory for obtaining good quality of images from the subclavian arteries to the femoral arteries. Chronic kidney disease is a common underlying disease in patients with severe AS and is significantly associated with aggravation of renal function in case of excessive use of iodinated contrast medium during both the pre-TAVR planning and TAVR procedure.3)4) Therefore, reducing the use of contrast medium for pre-procedural CTA imaging in TAVR is required for prevention of deteriorating renal function and worsening clinical outcomes in patients with renal dysfunction.