Key result
3D printed aortic root models correctly identified the site of paravalvular leak in 8 of 10 patients with PVL and predicted the lack of PVL in 9 of 10 patients without PVL.
Why the study?
Does ex-vivo 3D printing and implantation of aortic root models predict paravalvular regurgitation locations after TAVR in patients with severe calcific aortic stenosis?
Observational (n=20)
Does ex-vivo 3D printing and implantation of aortic root models predict paravalvular regurgitation locations after TAVR in patients with severe calcific aortic stenosis?
Patient-specific 3D printed aortic root models can accurately predict the presence and location of paravalvular leak after TAVR, potentially aiding in optimal valve selection and sizing.
3D-printed models may predict paravalvular regurgitation sites post-TAVR; hypothesis-generating and requires prospective validation before clinical use.
BACKGROUND: There is no effective method to predict paravalvular regurgitation prior to transcatheter aortic valve replacement (TAVR). METHODS: We retrospectively analyzed pre-TAVR computed tomography (CT) scans of 20 patients who underwent TAVR for severe, calcific aortic stenosis and subsequently printed 3-dimensional (3D) aortic root models of each patient. Models were printed using Ninjaflex thermoplastic polyurethane (TPU) (Ninjatek Manheim, PA) and TPU 95A (Ultimaker, Netherlands) on Ultimaker 3 Extended 3D printer (Ultimaker, Netherlands). The models were implanted at nominal pressure with same sized Sapien balloon-expandable frames (Edwards Lifesciences, CA) as received in-vivo. Ex-vivo implanted TAVR models (eTAVR) were scanned using Siemens SOMATOM flash dual source CT (Siemens, Malvern, PA) and then analyzed with Mimics software (Materialize NV, Leuven, Belgium) to evaluate relative stent appositions. eTAVR were then compared to post-TAVR echocardiograms for each patient to assess for correlations of identified and predicted paravalvular leak (PVL) locations. RESULTS: A total of 20 patients (70% male) were included in this study. The median age was 77.5 (74-83.5) years. Ten patients were characterized to elicit mild (9/10) or moderate (1/10) PVL, and 10 patients presented no PVL. In patients with echocardiographic PVL, eTAVR 3D model analyses correctly identified the site of PVL in 8/10 cases. In patients without echocardiographic PVL, eTAVR 3D model analyses correctly predicted the lack of PVL in 9/10 cases. CONCLUSION: 3D printing may help predict the potential locations of associated PVL post-TAVR, which may have implications for optimizing valve selection and sizing.
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Reiff et al. (2020) conducted an observational in Severe, calcific aortic stenosis (n=20). 3D printed aortic root models vs. Post-TAVR echocardiograms was evaluated on Correlation of identified and predicted paravalvular leak (PVL) locations. 3D printed aortic root models correctly identified the site of paravalvular leak in 8 of 10 patients with PVL and predicted the lack of PVL in 9 of 10 patients without PVL.
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