Transcatheter Heart Valve Handbook: A Surgeons' and Interventional Council Review

Editor's Note: The Transcatheter Heart Valve Handbook is an overview document developed by the ACC's Surgeons' and Interventional Member Sections. This source of introductory information about transcatheter valve technologies should be used as an adjunct to other educational texts, journal articles, and clinical experiences.

As the field of transcatheter heart valve interventions has exponentially expanded in the last decade, so has the variety of settings and operators involved. The expanding indications for transcatheter aortic valve replacement (TAVR) have increased the number of patients eligible for the procedure. Transcatheter heart valve interventions are now performed at an increasing number of institutions with teams of varied backgrounds. The American College of Cardiology (ACC) Surgeons' Section Leadership Council, under the guidance of Dr. Thourani and Dr. Phillips, designed the Transcatheter Heart Valve Handbook as a document for trainees, staff, and primary operators to learn the background and technical aspects of the procedures, as well as to share best practices around team organization and structure. The goal of this handbook is to provide a single source of introductory information on aortic, mitral, and pulmonary transcatheter valve technology. Because this field is evolving at a rapid pace, standard textbooks do not provide the necessary content for trainees who wish to develop an understanding of this technology as they proceed through their rotations in structural heart disease. The text provides the reader with a necessary understanding of the fundamentals, pre- and post-procedure assessment and management, and technical aspects of modern transcatheter valve interventions. The history of percutaneous valves, starting with the first human implant of a pulmonary transcatheter valve in 2000, and the major clinical trials underpinning the technology used today are reviewed. Chapters include the multimodality imaging used for pre-procedural assessment of aortic, mitral, and pulmonary valve interventions and intra-procedural echocardiographic guidance (Table 1).

The handbook is meant to be a living document that will be updated as technologies change. As a testament to the mission of the ACC as the professional home for the cardiovascular team, the handbook was written by both cardiologists and cardiac surgeons, as well as trainees from both fields. ACC's Interventional Council collaborated with the Surgeons' Council with the expertise of both authors and reviewers. The editors solicited experts in the field to write each chapter and specifically requested trainees to be first authors. The content was first reviewed by the editors and then by content experts. Contributors span institutions from around the country.

The handbook was published online concurrently with the ACC.18 Scientific Sessions. As a testament to the multidisciplinary collaboration and educational mission, it was awarded the ACC All Section Award for Best Project of the Year.

The handbook is available free of charge on at

Future editions of the handbook will include chapters on emerging transcatheter tricuspid valve therapies and more comprehensive discussion and information on the role of the operative and catheterization laboratory team(s), in collaboration with ACC's Cardiovascular Team Section.

This handbook would not have been possible without the teamwork between the ACC's Surgeons' Section and Interventional Section Leadership Councils, the dedication of our authors and reviewers, and the support of ACC staff, in particular our project manager and copy editor Abby Bledsoe Cestoni and the ACC web team. Please contact us with any questions or comments or to get involved in future editions: or @DrAdaStefanescu, @DrIribarne, and @tomcnguyen.

Table 1: Handbook Table of Contents

  Part I - Essential Concepts in Structural Interventions
  Part I - Essential Concepts in Structural Interventions
  1. Surgical anatomy of the aortic and mitral valves
    • Jordan Hoffman, MD and David Fullerton, MD, FACC
      UC Denver
  2. Standard wires and balloons used in TAVR
    • Manoj Thangam, MD and Prakash Balan, MD, FACC
      McGovern Medical School
  3. Fluoroscopy and contrast: angles, doses, and radiation safety
    • Firas Zahr, MD, FACC and Joaquin E. Cigarroa, MD, FACC
      Oregon Health & Sciences University
  4. Basics of echocardiography for transcatheter interventions
    • Adrian DaSilva-DeAbreu, MD and Catalin Loghin, MD
      UT Houston
  5. The role of the heart team
    • Michael N. Young, MD; Vikas Singh, MD; Amy Fiedler, MD; Serguei Melnitchouk, MD; Igor Palacios, MD; Ignacio Inglessis, MD; Michael G. Fitzsimons, MD, Jonathan J. Passeri, MD
      Massachusetts General Hospital
  Part II - Transcatheter Aortic Valve Replacement
  Part II - Transcatheter Aortic Valve Replacement
  1. History of TAVR
    • Bryan Piccirillo, MD and Pinak Bipin Shah, MD, FACC
      Brigham and Women's Hospital
  2. The evidence base for TAVR: landmark trials
    • Rachel Easterwood, MD and Ajay Kirtane, MD, FACC
      Columbia University Medical Center
  3. Diagnostic workup and evaluation: eligibility, risk assessment, FDA guidelines
    • Iliana Hurtado Rendon, MD, Peter Bittenbender, MD, Justin M. Dunn, MD, MPH, and Michael S. Firstenberg, MD, FACC
      Summa Health and The Medical Center of Aurora
  4. Cardiac imaging for TAVR: CTA, TTE, TEE, and valve sizing
    • Lucy M. Safi, DO, FACC, Brian Ghoshhajra, MD, MBA and Jonathan J. Passeri, MD
      Massachusetts General Hospital
  5. Step-by-step guide: transfemoral Sapien S3 TAVR
    • Omar Hadidi, MD and Tom C. Nguyen, MD, FACC
      UT Houston
  6. Step-by-step guide: transfemoral Corevalve Evolut TAVR
    • Ankur Kalra, MBBS, FACC, Michael Reardon, MD, FACC, Colin Barker, MD, FACC, Neal Kleiman, MD, FACC, and Manuel Reyes, MD
      Houston Methodist
  7. Step-by-step guide: Transapical Sapien S3 TAVR
    • Chase Brown, MD and Nimesh Desai, MD, PhD
      Penn Medicine
  8. Step-by-step guide: Subclavian Corevalve Evolut TAVR
    • Adam Williams, MD and Jeffrey Gaca, MD
      Duke University School of Medicine
  9. Step-by-step guide: Percutaneous Transaxillary TAVR with S3
    • Sankeep K. Krishnan, MD, Moses Mathur, MD, FACC, and James McCabe, MD, FACC
      University of Washington
  10. Step-by-step guide: Trans-carotid, trans-caval, and direct aortic
    • Frans van Wagenberg, MD and Michael Jessen, MD, FACC
      UT Southwestern
  11. Valve-in-valve TAVR
    • Bibhu Mohanty, MD, Vishesh Kumar, MD, and James T. Devries, MD, FACC
      USF Health and Dartmouth-Hitchcock
  12. Management of procedural complications in the cath lab/hybrid OR
    • Amit Pawale, MD, Syed Zaid, MD, and Gilbert Tang, MD, MSC, MBA, FACC
      Mount Sinai Medical Center
  13. Post-procedure management: complications; anticoagulation, standard pathways, discharge instructions and follow-up
    • Gregory Pattakos, MD and Joseph Coselli, MD, FACC
      Texas Heart Institute and Baylor College of Medicine
  14. Current controversies, ongoing trials, new valves, and future directions
    • Sukhdeep S. Basra, MD, MPH and Michael J. Mack, MD, FACC
      The Heart Hospital Baylor Plano, Texas
  15. Cost-effective Analysis of TAVR
    • Jennifer L. Perri, MD, MBA and Alexander Iribarne, MD, MS
      Dartmouth-Hitchcock Medical Center
  16. Palliative care and TAVR
    • Jill Steiner, MD and James Kirkpatrick, MD, FACC
      University of Washington
  Part III - Transcatheter Mitral Valve Repair
  Part III - Transcatheter Mitral Valve Repair
  1. The history of transcatheter mitral valve technology
    • Moritz C. Wyler von Ballmoos, MD, PhD, MPH, FACC and Vinay Badhwar, MD, FACC
      Duke University and West Virginia University
  2. The evidence base for TMVr: the EVEREST Trials
    • Muath Bishawi, MD and Donald Glower, MD, FACC
      Duke University
  3. Diagnostic workup and evaluation: eligibility, risk assessment, FDA guidelines
    • Ashwin Nathan, MD and Saif Anwaruddin, MD, FACC
      Hospital of the University of Pennsylvania
  4. Cardiac imaging for TMVr - TTE and TEE
    • Evin Yucel, MD, FACC and Jacob Dal-Bianco, MD, FACC
      Massachusetts General Hospital
  5. Step-by-step guide: Transseptal MitraClip
    • Amy Gin, MD, FACC, Ramon Partida, MD, FACC, Sammy Elmariah, MD, MPH, FACC, and Rahul Sakhuja, MD, MPP, MSc FACC
      Massachusetts General Hospital
  6. Transfemoral/Transseptal Mitral Valve-in-Valve using Sapien 3
    • S. Chris Malaisrie, MD, FACC, Mark J. Ricciardi, MD, FACC, and Charles Davidson, MD, FACC
      Northwestern Memorial Hospital
  7. Future transcatheter mitral valve repair/replacement technology
    • Syed Zaid, MD, Gilbert Tang, MD, MSC, MBA, FACC and Ahmed El-Eshmawi, MD
      Mount Sinai Medical Center
  8. Current controversies, active trials, and future directions
    • Michael Kayatta, MD and Vinod Thourani, MD, FACC
      Emory University and Medstar
  Part IV - Transcatheter Pulmonic Valve Repair
  Part IV - Transcatheter Pulmonic Valve Repair
  1. The history and evidence base for transcatheter pulmonic valve replacement
    • Varun Aggarwal, MD, Athar Quershi, MD, and Lauren Christine Kane, MD, FACC
      Texas Children's
  2. Cardiac imaging for TPVr: evaluation, planning, and intra-procedural use
    • Zachary Steinberg, MD, Rose Tompkins, MD, and Doff McElhinney, MD
      University of Washington and Stanford University
  3. Step-by-step guide: Melody valve implantation
    • Brian Morray, MD, Zachary Steinberg, MD, and Thomas Jones, MD, FACC
      University of Washington

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Noninvasive Imaging, Valvular Heart Disease, Aortic Surgery, Cardiac Surgery and VHD, Interventions and Imaging, Interventions and Structural Heart Disease, Echocardiography/Ultrasound

Keywords: Transcatheter Aortic Valve Replacement, Pulmonary Valve, Tricuspid Valve, Aortic Valve, Heart Valve Prosthesis, Surgeons, Echocardiography, Heart Diseases, Catheterization, Heart Valve Diseases

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