Background

Despite over 20 years of Transcatheter Aortic Valve Implantation (TAVI), patient outcome success relies on a number of factors that are yet to be optimised and there is a lack of uniformity in procedural safety and quality. TAVI is a minimally invasive procedure used to replace a stenotic aortic valve1,2. The literature thus far has illustrated pre and postoperative recommendations for TAVIs, including the criteria involved in selecting patients for TAVIs to the exploration of post operational outcomes for TAVI patients3,4,5. However, there is limited to no information on a standardised practice for TAVIs including the breakdown of the steps involved. The involvement of machine learning and artificial Intelligence(AI) in imaging modalities for cardiac procedures has also been recognised and researched, which shows potential for the implementation of AI in TAVI procedures6,7. This quantitative prospective cohort study is novel in its approach to evaluating how the TAVI procedural variations influence complication rates, recovery trajectories and key clinical outcomes in >100 cases curating a standardised protocol for TAVI procedures.

Objective

This study investigates the quality and completeness of end-state imaging datasets in TAVI and utilises the novel SXR® platform to capture end-state imaging. The aim of this study is to explore predictive modelling linking procedural metrics such as fluoroscopy, pacing during, valve position with the SXR® platform of procedural step tagging, chaptering and analysis.

Methodology

This prospective quantitative cohort study was conducted on the SXR ® platform.

Patient selection was conducted through the cardiology clinic referrals and interdisciplinary Sydney Heart Team.

A Stratified Random Sampling strategy was used to collate the data from the 15month period February 2024-May 2025. TAVI recordings on the SXR ® platform were mapped with time stamps, stages and chapters in chronological order including 20 steps: Prep and Drape, Pacing access, Tavi access, Pigtail access, Preclose Femoral Artery for TAVI Access, Stiff access wire, TAVI sheath, CEP insertion, Aortic root Angiogram capture, Cross AV, LV wire stiff exchange, Balloon Aortic Valve, TAVI Check, TAVI delivery sheath to descending aorta, TAVI across Aortic valve, TAVI release, TAVI deploy assessment (AO/LV Pressure) and TAVI deploy assessment (Root Angiogram), CEP removal, TAVI sheath removal, Access close and Angiogram. Start time, End time and End stage Images were recorded for each stage. The type of device, valve and deployment were also documented to then compare their effectiveness.