Differences in clinical valve size selection and valve size selection for patient-specific computer simulation in transcatheter aortic valve replacement (TAVR): a retrospective multicenter analysis

Nahid El Faquir,Johan Bosmans,Nicolas M Van Mieghem,Peter P T De Jaegere,Peter Mortier,Ole De Backer,Giorgia Rocatello,Zouhair Rahhab

doi:10.1007/s10554-019-01688-5

Abstract

Valve size selection for transcatheter aortic valve replacement (TAVR) is currently based on cardiac CT-scan. At variance with patient-specific computer simulation, this does not allow the assessment of the valve-host interaction. We aimed to compare clinical valve size selection and valve size selection by an independent expert for computer simulation. A multicenter retrospective analysis of valve size selection by the physician and the independent expert in 141 patients who underwent TAVR with the self-expanding CoreValve or Evolut R. Baseline CT-scan was used for clinical valve size selection and for patient-specific computer simulation. Simulation results were not available for clinical use. Overall true concordance between clinical and simulated valve size selection was observed in 47 patients (33%), true discordance in 15 (11%) and ambiguity in 79 (56%). In 62 (44%, cohort A) one valve size was simulated whereas two valve sizes were simulated in 79 (56%, cohort B). In cohort A, concordance was 76% and discordance was 24%; a smaller valve size was selected for simulation in 10 patients and a larger in 5. In cohort B, a different valve size was selected for simulation in all patients in addition to the valve size that was used for TAVR. The different valve size concerned a smaller valve in 45 patients (57%) and a larger in 34 (43%). Selection of the valve size differs between the physician and the independent computer simulation expert who used the same source of information. These findings indicate that valve sizing in TAVR is still more intricate than generally assumed.

Highlights

Transcatheter aortic valve replacement (TAVR) is an accepted treatment in patients with severe aortic stenosis at a high or intermediate operative risk [1–5]
The study population consisted of 141 patients who had undergone TAVR with the self-expanding Medtronic valve (CoreValve [MCS] or Evolut R) because of native tricuspid aortic stenosis and in whom patient-specific computer simulation was performed for the assessment and prediction of valve performance
The valve size selected for the clinical implantation (TAVR) was decided by the physician based upon preprocedural multi-slice computed tomography (MSCT) as previously described [14]

Summary

Introduction

Transcatheter aortic valve replacement (TAVR) is an accepted treatment in patients with severe aortic stenosis at a high or intermediate operative risk [1–5]. Different valve types and sizes are available allowing optimal. Copenhagen, Denmark 5 FEops NV, Ghent, Belgium transcatheter valve performance and clinical outcome in a wide range of patients [5–8]. Computed tomography (CT) scan of the heart is the standard method and recommended for selection of the valve size [9]. This does not allow the prediction of the mechanical interaction and precise outcome between the device and host. The purpose of this study was to compare transcatheter valve size selection between the physician for TAVR and the independent expert for the purpose of patient-specific computer simulation

Objectives

Methods

Results

Conclusion