Comprehensive Assessment of Aortic Stenosis in the TAVR Era

Transcatheter aortic valve replacement (TAVR) has been approved for the treatment of severe aortic stenosis in patients who are prohibitive surgical risk, high surgical risk, and now intermediate surgical risk. This review aims to raise awareness of the role echocardiography in evaluating patients with aortic stenosis for TAVR, in assisting during the procedure for device placement and to identify procedural complications and in assessing follow-up valvular and cardiac function to guide ongoing therapy.

A comprehensive echocardiogram is an essential part of the evaluation of patients with aortic stenosis. Severe aortic stenosis is present in patients with a peak aortic velocity of > 4 m/s, mean gradient > 40 mmHg, and AVA < 1.0 cm2. In patients with reduced LV systolic function, dobutamine echocardiography may help differentiate patients with true low-gradient aortic stenosis from patients with pseudo-aortic stenosis. Echocardiography is used in conjunction with fluoroscopy to assist with valve placement and is important in identifying procedural complications including paravalvular regurgitation. Follow-up echocardiography is strongly recommended at 30 days following the procedure and then annually to assess valvular function and hemodynamic effects following correction of the aortic stenosis.

In the TAVR era, echocardiography will play a critical role in the evaluation and treatment of the patient with aortic stenosis.