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Transcatheter aortic valve replacement or TAVR has become the gold standard for the treatment of symptomatic and severe aortic valve stenosis in elderly patients. Although the role of computed tomography imaging was initially limited to the determination of the optimal vascular approach, it has progressively matured to become the pilar of TAVR work-up while being standardized by consensus conferences. The list of evaluated elements includes aortic annulus diameter, the optimal projection curve, the number of aortic leaflets, the severity and localization of calcifications, coronary ostial height, membranous septum length and aortic angulation. The proper and cautious evaluation of these elements may help evaluating the risk for the main periprocedural complications such as coronary obstruction, annular rupture, permanent pacemaker implantation or procedural failure and selecting the optimal transcatheter heart valve and its size, according to the patient's specific anatomy. In this review, we detail how the evaluation of these parameters may impact the selection of the transcatheter heart valve.

Aortic stenosis remains one of the most frequent valvulopathy worldwide, burdened with great mortality and morbidity, and for which there is not yet an effective preventive approach, although the pathophysiological mechanisms involved in its development are better understood nowadays. Its cure, however, has been revolutionized in the last decade by the advent of transcatheter aortic valve implantation, or TAVI (also named transcatheter aortic valve replacement or TAVR). The technique of TAVI has been refined and its indications has been extended, following the publication of large randomized controlled trials where it was compared to surgical aortic valve replacement with favorable results. Consequently, transfemoral TAVR has become the first line of treatment in case of symptomatic severe aortic valve stenosis. In this review, we describe the pathophysiological mechanisms leading to severe aortic stenosis and the main ongoing randomized controlled trials targeting them. We describe the indication for surgical or percutaneous aortic valve replacement and the main complications following the procedure.

National audience; Depuis le début des années 2000 s’est affirmée une volonté de mieux rationaliser les stratégies gouvernementales de soutien à la parentalité en les fondant sur les données scientifiques, dans une démarche dite « evidence based ». Si cette ambition semble peu contestable, jusqu’où est-elle conciliable avec la complexité et la diversité des modalités de construction de la parentalité ?