Proof of Concept: Measuring Aortic Annulus Resistance by Means of Pressure-Volume Curves During Balloon Inflation to Guide Transcatheter Aortic Valve Implantation.

Timothée Noterdaeme,Nikolaus Marx,Jonas Gesenhues,Steffen Massberg,Felix Vogt

doi:10.3389/fcvm.2021.665029

Abstract

This study assessed the basic working principle to measure aortic annulus resistance during balloon inflation for transcatheter aortic valve implantation (TAVI), by acquisition of pressure-volume curve for a guided semi-automatic implantation. A modular bench-system was used which allows the incremental inflation of valvuloplasty balloons by means of a stepper-motor driven linear axis with simultaneous recording of the pressure changes inside the system. Different porcine aortic xenografts were assessed by use of a non-compliant valvuloplasty balloon. In a second step transcatheter aortic stents were implanted inside target sized xenografts. The recorded pressure volume-curves showed that the system can accurately differentiate between different xenografts and assess the quality of the tissue rendering real-time analysis of pressure-volume curves during balloon-inflation possible, which has the potential to optimize the implantation procedure by direct adaptation to the patient specific anatomy and characteristics. Further investigations and development are warranted.

Highlights

Transcatheter aortic valve implantation (TAVI) for aortic stenosis has moved toward the treatment of low-risk patients with good short-term results [1]
We evaluated the concept of acquiring pressure-volume curves during balloon inflation to directly assess local tissue characteristics of the aortic annulus, which could potentially be used to control a semi-automated implantation system for guiding the expansion and final modulation of transcatheter aortic valve implantation (TAVI) prostheses inside the native aortic valve
Pressure-volume curves of the different sized xenografts are shown in Figure 2 in comparison to the curve of the balloon

Summary

INTRODUCTION

Transcatheter aortic valve implantation (TAVI) for aortic stenosis has moved toward the treatment of low-risk patients with good short-term results [1]. In this younger population, the lingering problems of paravalvular leakage (PVL), valve deterioration as well as the still existing necessity for pacemaker implantation, even with the latest TAVI-generation [2, 3], might affect the long-term outcome and hinder further implementation. The interaction between the host and the used TAVI prostheses can be approximated beforehand by computerbased simulations yet remains fragmented due to the high variability of the individual tissue characteristics of each patient This information has remained almost impossible to implement during the implantation procedure itself. We evaluated the concept of acquiring pressure-volume curves during balloon inflation to directly assess local tissue characteristics of the aortic annulus, which could potentially be used to control a semi-automated implantation system for guiding the expansion and final modulation of TAVI prostheses inside the native aortic valve

MATERIALS AND METHODS

DISCUSSION

DATA AVAILABILITY STATEMENT