Peak areal stretch derived from 3D computational modeling predicted aortic root rupture with an AUC of 0.81, outperforming traditional metrics like calcium score and valve oversizing.
Cohort (n=66)
Blinded
Does 3D computational modeling of peak areal stretch better predict aortic root rupture in TAVR patients compared to traditional factors?
Computational modeling of peak areal stretch provides a superior patient-specific predictor of aortic root rupture during TAVR compared to traditional metrics.
Effect estimate: AUC 0.81
p-value: p=0.0285
Background Aortic root rupture is a rare but lethal complication of transcatheter aortic valve replacement (TAVR). It is often the result of excessive radial forces experienced by the aorta during stent deployment. Current pre-procedural planning methods lack the predictive ability to capture interactions between the patient's native anatomical tissue and the transcatheter heart valve. Objectives This study aimed to investigate whether 3-dimensional (3D) computational modeling could be used to derive a biomarker that analyzed peak areal stretch to predict patient-specific risk for aortic root rupture. Methods In a 2-phase study, a derivation cohort (n = 26) was used to establish a peak areal stretch threshold for rupture risk, followed by a blinded validation cohort (n = 40) where modeling was performed using the federal drug administration-cleared PrecisionTAVI software. Researchers were blinded to the clinical outcomes of each case until after computational analysis had been completed. Peak areal stretch's predictive ability was compared to traditional factors such as calcium score or valve oversizing. Results A significant association was found between peak areal stretch and aortic root rupture. Rupture-positive cases had a higher mean stretch (1.956 ± 0.216) than negative cases (1.635 ± 0.284, P = .0285). A threshold of 1.6 showed strong predictive performance with an area under the curve (AUC) of 0.81, outperforming traditional metrics such as calcium score (AUC = 0.643) and valve oversizing (AUC = 0.697). Conclusion Peak areal stretch derived from computational modeling may serve as a patient-specific predictor of aortic root rupture, with potential to improve pre-TAVR planning and patient outcomes.
Becker et al. (Mon,) conducted a cohort in Transcatheter aortic valve replacement (TAVR) (n=66). Peak areal stretch derived from 3D computational modeling vs. Traditional metrics (calcium score, valve oversizing) was evaluated on Aortic root rupture (AUC 0.81, p=0.0285). Peak areal stretch derived from 3D computational modeling predicted aortic root rupture with an AUC of 0.81, outperforming traditional metrics like calcium score and valve oversizing.