Patient-specific computer modelling – its role in the planning of transcatheter aortic valve implantation

Nahid El Faquir; Ben Ren; Nicolas M. Van Mieghem; Johan Bosmans; Peter P. de Jaegere

doi:10.1007/s12471-016-0923-6

November 25, 2016Netherlands Heart JournalOpen Access

Patient-specific computer modelling – its role in the planning of transcatheter aortic valve implantation

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Why the study?

Does patient-specific computer modelling accurately predict frame geometry and paravalvular leakage in patients undergoing TAVI?

Structured PICO

Does patient-specific computer modelling accurately predict frame geometry and paravalvular leakage in patients undergoing TAVI?

P

Population

Patients with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI)

I

Intervention

Patient-specific computer modelling (TAVIguide) for pre-procedural planning using MSCT

O

Outcome

Prediction of frame morphology, dimensions, aortic leaflet displacement, and paravalvular leakage (PVL)surrogate

Patient-specific 3D computer modeling using pre-procedural CT can accurately predict TAVI frame geometry and paravalvular leakage, supporting tailored valve selection to minimize complications.

Limitations

Information stems from a selected series of patients in centres that perform high-quality MSCT
Current computer simulation program only offers simulation for a limited number of valve types
Clinical role needs to be further established by appropriately designed prospective and randomised clinical trials

Implication

Attention to device-host interactions may aid TAVI planning; leaves open whether patient-specific modelling improves outcomes.

Abstract

Transcatheter aortic valve implantation is increasingly used to treat patients with severe aortic stenosis who are at increased risk for surgical aortic valve replacement and is projected to be the preferred treatment modality. As patient selection and operator experience have improved, it is hypothesised that device-host interactions will play a more dominant role in outcome. This, in combination with the increasing number of valve types and sizes, confronts the physician with the dilemma to choose the valve that best fits the individual patient. This necessitates the availability of pre-procedural computer simulation that is based upon the integration of the patient-specific anatomy, the physical and (bio)mechanical properties of the valve and recipient anatomy derived from in-vitro experiments. The objective of this paper is to present such a model and illustrate its potential clinical utility via a few case studies.