1. The Impact of Size and Position of a Mechanical Expandable Transcatheter Aortic Valve: Novel Insights Through Computational Modelling and Simulation.
- Author
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Rocatello G, El Faquir N, de Backer O, Swaans MJ, Latib A, Vicentini L, Segers P, De Beule M, de Jaegere P, and Mortier P
- Subjects
- Aortic Valve diagnostic imaging, Aortic Valve physiopathology, Aortic Valve Insufficiency diagnostic imaging, Aortic Valve Insufficiency physiopathology, Aortic Valve Stenosis diagnostic imaging, Aortic Valve Stenosis physiopathology, Arrhythmias, Cardiac etiology, Arrhythmias, Cardiac physiopathology, Clinical Decision-Making, Europe, Hemodynamics, Humans, Multidetector Computed Tomography, Prosthesis Design, Risk Assessment, Risk Factors, Treatment Outcome, Aortic Valve surgery, Aortic Valve Insufficiency etiology, Aortic Valve Stenosis surgery, Heart Valve Prosthesis, Models, Cardiovascular, Patient-Specific Modeling, Transcatheter Aortic Valve Replacement adverse effects, Transcatheter Aortic Valve Replacement instrumentation
- Abstract
Transcatheter aortic valve implantation has become an established procedure to treat severe aortic stenosis. Correct device sizing/positioning is crucial for optimal outcome. Lotus valve sizing is based upon multiple aortic root dimensions. Hence, it often occurs that two valve sizes can be selected. In this study, patient-specific computer simulation is adopted to evaluate the influence of Lotus size/position on paravalvular aortic regurgitation (AR) and conduction abnormalities, in patients with equivocal aortic root dimensions. First, simulation was performed in 62 patients to validate the model in terms of predicted AR and conduction abnormalities using postoperative echocardiographic, angiographic and ECG-based data. Then, two Lotus sizes were simulated at two positions in patients with equivocal aortic root dimensions. Large valve size and deep position were associated with higher contact pressure, while only large size, not position, significantly reduced the predicted AR. Despite general trends, simulations revealed that optimal device size/position is patient-specific.
- Published
- 2019
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