Abstract
BackgroundThree-dimensional (3D) models have the unique ability to replicate individualized cardiac anatomy and may therefore provide clinical benefit. Transcatheter aortic valve implantation (TAVI) currently relies on preoperative imaging for accurate valve sizing, type of valve used, and avoidance of complications. Three-dimensional (3D) modelling may provide benefit for optimal preoperative TAVI planning. The goal of this study is to assess the utility of 3D modelling in the prediction of paravalvular leak (PVL) post TAVI.MethodsRetrospective analysis of five patients who underwent TAVI at our center. Pre-operative cardiac gated CT images were utilized to create a 3D printed model with true size aortic root dimensions, including the coronary artery ostium location and left ventricular outflow tract. Deployment of the corresponding model and size TAVI valve into the created 3D model at a similar depth of implantation via fluoroscopy was performed for each patient. Degree of PVL was assessed using a closed system with water infusion under pressure over a duration of 5 s. Correlation was made between the volume obtained in the closed loop model during the pressurized period and the degree of PVL reported on the patients post TAVI placement on transthoracic echocardiogram.ResultsOne female, and four males (age in years ranged from 68 to 87) underwent successful TAVI (0% 30-day mortality). PVL on post procedure TTE ranged from none to trivial. Successful deployment of TAVI valves inside the 3D model occurred in all cases. The average volume of water collected on three trials over 5 s ranged between 19.1–24.1 ml A multivariate linear regression showed significant association between the degree of PVL reported on post-operative transthoracic echocardiogram and the amount of volume detected in the 3D model (difference: -3.9657, 95% CI: (− 4.6761,-3.2554), p < 0.001).ConclusionsOur experiments show that replicated 3D models have potential clinical utilization in predicting PVL in the TAVI population. Future research into the role of 3D modelling in the field of TAVI should continue to be explored.
Highlights
Three-dimensional (3D) models have the unique ability to replicate individualized cardiac anatomy and may provide clinical benefit
Pre-operative imaging techniques are critical for successful Transcatheter aortic valve implantation (TAVI), with incorrect decisions leading to potential valve embolization, paravalvular leak (PVL), and/ or annular/aortic root rupture [2]
Using a linear regression model controlled for the sex of the patient, the average volume recorded on the trials on the 3D model implantation was compared to the amount of leak assessed on the patient’s postoperative transthoracic echocardiogram
Summary
Three-dimensional (3D) models have the unique ability to replicate individualized cardiac anatomy and may provide clinical benefit. Transcatheter aortic valve implantation (TAVI) currently relies on preoperative imaging for accurate valve sizing, type of valve used, and avoidance of complications. Pre-operative imaging techniques are critical for successful TAVI, with incorrect decisions leading to potential valve embolization, paravalvular leak (PVL), and/ or annular/aortic root rupture [2]. Current imaging modalities do not always allow for perfectly accurate and intricate measurements of the patient’s anatomy and may not provide the exact contours of the aorta required for TAVI implantation [3]. The advent of 3D printing offers the ability to create precise models of a patient’s individual anatomy and may be even more effective in accurately assessing procedural complications and optimizing results [4, 5]
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