As transcatheter aortic valve replacement (TAVR) becomes more widely used across the US, TAVR specialists are realizing that the measurement method being used (CT angiography, transesophageal echocardiography, or traditional echocardiography) to determine the correct valve size is less important than storing those measurements in a central repository for later analysis.
With TAVR, a catheter is inserted in the groin and passed up to the heart (the procedure can also be done through the chest wall), avoiding the need for open-heart surgery. A replacement valve is compressed, advanced through the tube to the correct position within the aortic valve, and expanded. Some TAVR valves are mounted on a balloon to help with expansion; others are self-expanding.
In the US, TAVR is currently only indicated for patients at high risk for open-heart surgery, but trials are being conducted to investigate its use in the intermediate-risk group.
Accurate annular anatomy measurement is essential for the procedure, as it determines valve size selection. Correct valve sizing helps reduce complications such as paravalvular regurgitation, left main occlusion, and annular rupture.
The American College of Cardiology has begun creating guidelines for TAVR-related measurements. In general, 2D measurements of annular diameter are considered more limited because of the anatomy of the aortic valve cusps. 3D transesophageal echocardiography (TEE) can more accurately measure the annular aortic annulus and improve prediction of complications, according to ACC.
Regardless of the method is used, it’s vital to store the information centrally (e.g., in a CVIS), rather than in a department-only system, for two reasons. First, multiple modalities are often used during the measurement process, so storing the data in a CVIS ensures access to the results by all involved.
Second, a careful analysis of the initial measurement, the size valve placed, and the patient’s outcome after six months (or longer) is essential to improving patient outcomes over time. For example, patients whose anatomy falls in between two valve sizes should be evaluated after the procedure to determine whether using the smaller size results in better outcomes than using the larger size (or vice versa).
Geographic factors such as elevation can also affect the results of the procedure, so hospitals will want to carefully track outcomes for use in developing a site-specific quality improvement program.
More than 150,000 TAVR valves have been implanted worldwide, so data about their durability is beginning to accumulate. By using a CVIS to store data about the procedure, hospitals can not only develop a successful internal quality program, they can more easily share their data with ACC and other relevant organizations.
Going to ACC April 2-4 in Chicago? Visit McKesson booth 9061 to learn more about McKesson’s CVIS solution, request a demo or contact us for more information.