Assessment of Coronary Artery Obstruction Risk During Transcatheter Aortic Valve Replacement Utilising 3D Printing

Abstract

Introduction: Current imaging techniques inadequately rule out coronary artery obstruction (CAO), a potentially fatal complication during transcatheter aortic valve replacement (TAVR). Advancements in 3D-printing may allow the development of models capable of replicating cardiac anatomy and predicting CAO. We sought to simulate TAVR utilising this 3D-technology to improve CAO risk assessment and procedural safety. Methodology: Eleven patients with aortic stenosis at high risk of CAO during TAVR were selected for 3D-printed modelling. The relevant anatomy to perform TAVR was precisely reconstructed from CT imaging with Materialise Heart Print-Flex technology. An appropriately sized valve prosthesis was deployed in vitro in each 3D-printed model and coronary ostia were assessed for obstruction. Results: Model-derived results were compared to clinical outcomes. Two high-risk TAVR cases were abandoned following transient CAO during balloon aortic valvuloplasty (BAV). In both cases, the 3D-model precisely simulated the clinical findings, demonstrating complete CAO either by a prominent calcium nodule or by the valve leaflet itself. In another case, the BAV outcome was uncertain, but the 3D-simulation demonstrated patency and successful TAVR implantation was undertaken with no obstruction. In other cases, no obstruction was demonstrated, and all underwent successful and uncomplicated TAVR. Conclusion: In this proof of concept study, model-derived TAVR simulation appears to correlate well to clinical outcomes. 3D-printed models of patients at high-risk of CAO may be utilised in pre-procedural planning to accurately predict this complication. 3D-models may help minimise TAVR complications leading to safer patient outcomes, especially as lower-risk surgical cohorts are considered in the future.