Underfilled Balloon-Expandable Transcatheter Aortic Valve Implantation With Ad Hoc Post-Dilation ― Pulsatile Flow Simulation Using a Patient-Specific Three-Dimensional Printing Model ―
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Key result
Excessive TAVI underfilling worsens hemodynamics in 3D models, but post-dilation improves expansion and reduces PVL.
- n=1
Why the study?
The effects of underfilled transcatheter aortic-valve implantation with ad hoc post-dilation on valve leaflet behavior, hydrodynamic performance, and paravalvular leakage were not well understood.
Does underfilled balloon-expandable transcatheter aortic valve implantation with ad hoc post-dilation affect valve leaflet behavior, hydrodynamic performances, and paravalvular leakage in patient-specific 3D models?
Population
Patient-specific 3D aortic-valve models from a female octogenarian patient with borderline annulus
Comparison
Underfilled implantation (-3 cc, -2 cc, -1 cc) with ad hoc post-dilation vs nominal volume post-dilation
Design
Preclinical study using patient-specific 3D printed models and pulsatile flow simulation
Authors
Discussion
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Member takes
Implication
Alerts to risks of excessive TAVI underfilling; leaves open need for clinical validation of model-guided post-dilation.
Structured PICO
Does underfilled balloon-expandable transcatheter aortic valve implantation with ad hoc post-dilation affect valve leaflet behavior, hydrodynamic performances, and paravalvular leakage in patient-specific 3D models?
P
Population
A patient-specific 3D-printed aortic root model based on an 86-year-old female with severe aortic stenosis and a small annulus was used to simulate hemodynamics of underfilled TAVI.
I
Intervention
Underfilled transcatheter aortic-valve implantation (-3 cc, -2 cc, or -1 cc initial underfilling) with ad hoc post-dilation in a 3D printed model.
C
Comparator
Nominal volume post-dilation in the same 3D model.
O
Outcome
Valve leaflet behavior, hydrodynamic performances, and paravalvular leakage (PVL).surrogate
Excessive underfilling during TAVI results in unacceptable acute hemodynamics and abnormal leaflet motion in 3D patient-specific models, raising durability concerns.
Limitations
- Pre-/post-MDCT of the patient was retrospectively obtained.
- TAV leaflet was not duplicated in this study.
- Only one annulus slice in one patient was used for the construction of annulus stiffness.
- This study used the previous generation Sapien-XT.
Cite This Study
Yamawaki et al. (2018) studied Severe aortic stenosis (n=1). Underfilled balloon-expandable TAVI with ad hoc post-dilation vs. Nominal volume inflation was evaluated on Hydrodynamic performance (%PVL, %CV, cardiac output) and dynamic valve leaflet behavior. In a patient-specific 3D-printed model, excessive underfilled TAVI (-3 cc) resulted in unacceptable acute hemodynamics and distorted leaflet motions, whereas ad hoc post-dilation improved stent expansion and reduced paravalvular leakage.
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