SORA

Advancing, promoting and sharing knowledge of health through excellence in teaching, clinical practice and research into the prevention and treatment of illness

First-in-Human Experience With Patient-Specific Computer Simulation of TAVR in Bicuspid Aortic Valve Morphology.

Dowling, C; Firoozi, S; Brecker, SJ (2020) First-in-Human Experience With Patient-Specific Computer Simulation of TAVR in Bicuspid Aortic Valve Morphology. JACC Cardiovasc Interv, 13 (2). pp. 184-192. ISSN 1876-7605 https://doi.org/10.1016/j.jcin.2019.07.032
SGUL Authors: Brecker, Stephen

[img] PDF Accepted Version
Restricted to Repository staff only until 16 October 2020.
Available under License Creative Commons Attribution Non-commercial No Derivatives.

Download (4MB)

Abstract

OBJECTIVES: The aim of this study was to prospectively evaluate the clinical use of patient-specific computer simulation of transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) morphology. BACKGROUND: Patient-specific computer simulation of TAVR in BAV may predict important clinical outcomes, such as paravalvular regurgitation and conduction disturbance. METHODS: Between May 2018 and April 2019, all patients who were referred for TAVR who had BAV identified on work-up cardiac multidetector computed tomographic imaging prospectively underwent patient-specific computer simulation with a self-expanding transcatheter heart valve (THV) using TAVIguide technology. RESULTS: Nine patients were included in the study. Sievers classification was type 0 in 2 patients and type 1 in 7 patients. The simulations altered the treatment strategy in 8 patients (89%). The simulations suggested moderate to severe paravalvular regurgitation in 3 patients, who were referred for consideration of surgery. The remaining 6 patients underwent TAVR with a self-expanding THV. In 5 of these patients (83%), THV size and/or implantation depth was altered to minimize paravalvular regurgitation and/or conduction disturbance. In 1 patient, simulations suggested significant conduction disturbance after TAVR, and a permanent pacemaker was implanted before the procedure. Following treatment, all 9 patients had no to mild paravalvular regurgitation. The patient who had a pre-procedure permanent pacemaker implanted became pacing dependent, with underlying third-degree atrioventricular block. CONCLUSIONS: Patient-specific computer simulation of TAVR in BAV can be used to identify those patients where TAVR may be associated with unfavorable clinical outcomes. Patient-specific computer simulation may be useful to guide THV sizing and positioning for potential favorable clinical outcomes.

Item Type: Article
Additional Information: © 2020. This manuscript version is made available under the CC-BY-NC-ND 4.0 license http://creativecommons.org/licenses/by-nc-nd/4.0/
Keywords: aortic valve stenosis, bicuspid aortic valve, computer simulation, finite element analysis, heart valve prosthesis implantation, transcatheter aortic valve replacement, aortic valve stenosis, bicuspid aortic valve, computer simulation, finite element analysis, heart valve prosthesis implantation, transcatheter aortic valve replacement, 1102 Cardiovascular Medicine And Haematology, Cardiovascular System & Hematology
SGUL Research Institute / Research Centre: Academic Structure > Molecular and Clinical Sciences Research Institute (MCS)
Journal or Publication Title: JACC Cardiovasc Interv
ISSN: 1876-7605
Language: eng
Dates:
DateEvent
27 January 2020Published
16 October 2019Published Online
23 July 2019Accepted
Publisher License: Creative Commons: Attribution-Noncommercial-No Derivative Works 4.0
PubMed ID: 31629752
Go to PubMed abstract
URI: http://openaccess.sgul.ac.uk/id/eprint/111300
Publisher's version: https://doi.org/10.1016/j.jcin.2019.07.032

Actions (login required)

Edit Item Edit Item