Sealing Behavior in Transcatheter Bicuspid and Tricuspid Aortic Valves Replacement Through Patient-Specific Computational Modeling.

Xianbao Liu,Jiaqi Fan,Vanda Oliveira,Lars Sondergaard,Yuchao Guo,Xinping Lin,Jubo Jiang,Giorgia Rocatello,Qifeng Zhu,Yuxin He,Jian'An Wang,Peter Mortier,Huajun Li,Tim Dezutter

doi:10.3389/fcvm.2021.732784

Abstract

Background: Patient-specific computer simulation of transcatheter aortic valve replacement (TAVR) can provide unique insights in device-patient interaction.Aims: This study was to compare transcatheter aortic valve sealing behavior in patients with bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV) through patient-specific computational modeling.Methods: Patient-specific computer simulation was retrospectively performed with FEops HEARTguide for TAVR patients. Simulation output was compared with postprocedural computed tomography and echocardiography to validate the accuracy. Skirt malapposition was defined by a distance larger than 1 mm based on the predicted device-patient interaction by quantifying the distance between the transcatheter heart valve (THV) skirt and the surrounding anatomical regions.Results: In total, 43 patients were included in the study. Predicted and observed THV frame deformation showed good correlation (R2 ≥ 0.90) for all analyzed measurements (maximum diameter, minimum diameter, area, and perimeter). The amount of predicted THV skirt malapposition was strongly linked with the echocardiographic grading of paravalvular leakage (PVL). More THV skirt malapposition was observed for BAV cases when compared to TAV cases (22.7 vs. 15.5%, p < 0.05). A detailed analysis of skirt malapposition showed a higher degree of malapposition in the interleaflet triangles section for BAV cases as compared to TAV patients (11.1 vs. 5.8%, p < 0.05).Conclusions: Patient-specific computer simulation of TAVR can accurately predict the behavior of the Venus A-valve. BAV patients are associated with more malapposition of the THV skirt as compared to TAV patients, and this is mainly driven by more malapposition in the interleaflet triangle region.

Highlights

Transcatheter aortic valve replacement (TAVR) in patients with a bicuspid aortic valve (BAV) is becoming increasingly important due to expanding indications which include younger patients, as well as to global adoption
There was no significant difference in age between BAV and tricuspid aortic valve (TAV) patients (BAV: 76.4 ± 7.1 years old vs. TAV: 79.4 ± 6.2 years old, p = 0.164) or other baseline characteristics (Table 1)
Written informed consent was obtained from the individual(s) for the publication of any potentially identifiable images or data included in this article

Summary

Introduction

Transcatheter aortic valve replacement (TAVR) in patients with a bicuspid aortic valve (BAV) is becoming increasingly important due to expanding indications which include younger patients, as well as to global adoption. TAVR has become the standard of care for high-risk patients, and is expanding into younger, lower-risk patients, resulting in an increased amount of patients with BAV stenosis [1,2,3,4]. Efforts to increase our knowledge of how TAVR devices interact with BAVs remain important. The interaction of transcatheter heart valves with the aortic root is likely to be different between BAV and tricuspid aortic valve (TAV) patients. Patient-specific computer simulation of transcatheter aortic valve replacement (TAVR) can provide unique insights in device-patient interaction

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Results

Discussion

Conclusion