Modeling risk of coronary obstruction during transcatheter aortic valve replacement.
Aged
Aged, 80 and over
Aortic Valve
/ diagnostic imaging
Computed Tomography Angiography
Coronary Angiography
/ methods
Coronary Stenosis
/ diagnostic imaging
Decision Support Techniques
Female
Heart Valve Prosthesis
Humans
Male
Middle Aged
Models, Cardiovascular
Patient-Specific Modeling
Predictive Value of Tests
Prosthesis Design
Reproducibility of Results
Risk Assessment
Risk Factors
Transcatheter Aortic Valve Replacement
/ adverse effects
Treatment Outcome
CFD
FEA
TAVR
calcification
coronary obstruction
patient-specific
Journal
The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343
Informations de publication
Date de publication:
03 2020
03 2020
Historique:
received:
12
02
2018
revised:
06
04
2019
accepted:
16
04
2019
pubmed:
25
6
2019
medline:
24
3
2020
entrez:
25
6
2019
Statut:
ppublish
Résumé
In this study we aimed to evaluate risk of coronary obstruction during transcatheter aortic valve replacement and develop improved criteria based on computational modeling. Patient specific 3-dimensional models were constructed and validated for 28 patients out of 600 patients who were flagged as high risk for coronary obstruction (defined as meeting coronary ostium height < 14 mm and/or sinus of Valsalva diameter [SOVd] < 30 mm). The models consisted finite element analysis to predict the post- transcatheter aortic valve replacement native cusp apposition relative to the coronary ostium and were validated in vitro. The distance from cusp to coronary ostium (DLC) was derived from the 3-dimensional models and indexed with the coronary artery diameter to yield a fractional obstruction measure (DLC/d). Twenty-two out of 28 high-risk patients successfully underwent transcatheter aortic valve replacement without coronary obstruction and 6 did not. DLC/d between the 2 groups was significantly different (P < .00078), whereas neither coronary ostium height nor SOVd were significantly different (P > .32). A cutoff of DLC/d < 0.7 was predictive with 100% sensitivity and 95.7% specificity. The optimal sensitivity and specificity of coronary ostium height and SOVd in this high-risk group was only 60% and 40%, respectively, for cutoff coronary ostium height of 10 mm and SOVd of 30.5 mm. Three-dimensional modeling has the potential to enable more patients to be safely treated with transcatheter aortic valve replacement who have a low-lying coronary ostium or small SOVd. DLC/d is more predictive of obstruction than coronary ostium height and SOVd.
Identifiants
pubmed: 31230808
pii: S0022-5223(19)31030-X
doi: 10.1016/j.jtcvs.2019.04.091
pmc: PMC6859205
mid: NIHMS1529594
pii:
doi:
Types de publication
Journal Article
Validation Study
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
829-838.e3Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL119824
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL135505
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
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