3-Dimensional printing to predict paravalvular regurgitation after transcatheter aortic valve replacement.
Aged
Aged, 80 and over
Aortic Valve
/ diagnostic imaging
Aortic Valve Insufficiency
/ diagnostic imaging
Aortic Valve Stenosis
/ diagnostic imaging
Calcinosis
/ diagnostic imaging
Female
Heart Valve Prosthesis
Humans
Male
Models, Anatomic
Models, Cardiovascular
Predictive Value of Tests
Printing, Three-Dimensional
Prosthesis Design
Retrospective Studies
Risk Assessment
Risk Factors
Tomography, X-Ray Computed
Transcatheter Aortic Valve Replacement
/ adverse effects
Treatment Outcome
3D printing
outcomes
paravalvular leak
transcatheter valve replacement
Journal
Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions
ISSN: 1522-726X
Titre abrégé: Catheter Cardiovasc Interv
Pays: United States
ID NLM: 100884139
Informations de publication
Date de publication:
12 2020
12 2020
Historique:
received:
26
09
2019
revised:
29
11
2019
accepted:
10
02
2020
pubmed:
23
2
2020
medline:
10
8
2021
entrez:
21
2
2020
Statut:
ppublish
Résumé
There is no effective method to predict paravalvular regurgitation prior to transcatheter aortic valve replacement (TAVR). We retrospectively analyzed pre-TAVR computed tomography (CT) scans of 20 patients who underwent TAVR for severe, calcific aortic stenosis and subsequently printed 3-dimensional (3D) aortic root models of each patient. Models were printed using Ninjaflex thermoplastic polyurethane (TPU) (Ninjatek Manheim, PA) and TPU 95A (Ultimaker, Netherlands) on Ultimaker 3 Extended 3D printer (Ultimaker, Netherlands). The models were implanted at nominal pressure with same sized Sapien balloon-expandable frames (Edwards Lifesciences, CA) as received in-vivo. Ex-vivo implanted TAVR models (eTAVR) were scanned using Siemens SOMATOM flash dual source CT (Siemens, Malvern, PA) and then analyzed with Mimics software (Materialize NV, Leuven, Belgium) to evaluate relative stent appositions. eTAVR were then compared to post-TAVR echocardiograms for each patient to assess for correlations of identified and predicted paravalvular leak (PVL) locations. A total of 20 patients (70% male) were included in this study. The median age was 77.5 (74-83.5) years. Ten patients were characterized to elicit mild (9/10) or moderate (1/10) PVL, and 10 patients presented no PVL. In patients with echocardiographic PVL, eTAVR 3D model analyses correctly identified the site of PVL in 8/10 cases. In patients without echocardiographic PVL, eTAVR 3D model analyses correctly predicted the lack of PVL in 9/10 cases. 3D printing may help predict the potential locations of associated PVL post-TAVR, which may have implications for optimizing valve selection and sizing.
Sections du résumé
BACKGROUND
There is no effective method to predict paravalvular regurgitation prior to transcatheter aortic valve replacement (TAVR).
METHODS
We retrospectively analyzed pre-TAVR computed tomography (CT) scans of 20 patients who underwent TAVR for severe, calcific aortic stenosis and subsequently printed 3-dimensional (3D) aortic root models of each patient. Models were printed using Ninjaflex thermoplastic polyurethane (TPU) (Ninjatek Manheim, PA) and TPU 95A (Ultimaker, Netherlands) on Ultimaker 3 Extended 3D printer (Ultimaker, Netherlands). The models were implanted at nominal pressure with same sized Sapien balloon-expandable frames (Edwards Lifesciences, CA) as received in-vivo. Ex-vivo implanted TAVR models (eTAVR) were scanned using Siemens SOMATOM flash dual source CT (Siemens, Malvern, PA) and then analyzed with Mimics software (Materialize NV, Leuven, Belgium) to evaluate relative stent appositions. eTAVR were then compared to post-TAVR echocardiograms for each patient to assess for correlations of identified and predicted paravalvular leak (PVL) locations.
RESULTS
A total of 20 patients (70% male) were included in this study. The median age was 77.5 (74-83.5) years. Ten patients were characterized to elicit mild (9/10) or moderate (1/10) PVL, and 10 patients presented no PVL. In patients with echocardiographic PVL, eTAVR 3D model analyses correctly identified the site of PVL in 8/10 cases. In patients without echocardiographic PVL, eTAVR 3D model analyses correctly predicted the lack of PVL in 9/10 cases.
CONCLUSION
3D printing may help predict the potential locations of associated PVL post-TAVR, which may have implications for optimizing valve selection and sizing.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
E703-E710Informations de copyright
© 2020 Wiley Periodicals, Inc.
Références
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