Insight on patient specific computer modeling of transcatheter aortic valve implantation in patients with bicuspid aortic valve disease

Catheter Cardiovasc Interv. 2019 May 1;93(6):1097-1105. doi: 10.1002/ccd.27990. Epub 2018 Nov 20.

Abstract

Objective: The aim of this study was to describe the early use of dedicated patient specific computer modeling in patients with bicuspid aortic valve (BAV) undergoing transcatheter aortic valve implantation (TAVI), in predicting procedure feasibility and patient related outcome.

Background: Dedicated patient specific computer modeling, used for optimizing TAVI procedures, is currently validated for the prediction of contact pressure, valve morphology and paravalvular leakage (PVL). The simulation of TAVI procedures is increasingly used in patients with tricuspid aortic valve stenosis. Currently, BAV disease is considered as a relative contra-indication for TAVI due to its specific anatomical characteristics.

Methods: This single center study consisted of seven patients with BAV undergoing TAVI. A patient specific computer simulation was performed based on multislice computer tomography images. The model advised the best fitting prosthetic valve size or sizes and simulated this valve on different implantation depths with the corresponding presence and severity of PVL and prosthetic valve morphology. The simulation results were compared with the procedural outcomes using transesophageal echocardiography (TEE) and fluoroscopy.

Results: The patient specific computer modeling predicted accurately the outcome (PVL and valve morphology) of TAVI in all cases. In one case, the TAVI procedure was unsuccessful and retrospectively not suitable for TAVI, which was correctly predicted by the model.

Conclusion: The patient specific computer modeling adequately predicts feasibility and outcome of TAVI in patients with BAV disease and may extend the applicability of TAVI. Moreover, it improves decision-making and therefore individual procedural outcomes in this difficult patient population.

Keywords: aortic valve disease; electron beam CT/multidetector CT; imaging; percutaneous intervention; transcatheter valve implantation.

Publication types

  • Case Reports
  • Comparative Study

MeSH terms

  • Aged
  • Aged, 80 and over
  • Aortic Valve / abnormalities*
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / physiopathology
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / etiology
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery*
  • Clinical Decision-Making
  • Decision Support Techniques
  • Feasibility Studies
  • Female
  • Heart Valve Diseases / complications*
  • Heart Valve Diseases / diagnostic imaging
  • Heart Valve Diseases / physiopathology
  • Heart Valve Prosthesis
  • Humans
  • Male
  • Models, Cardiovascular*
  • Multidetector Computed Tomography
  • Patient Selection
  • Patient-Specific Modeling*
  • Prosthesis Design
  • Retrospective Studies
  • Surgery, Computer-Assisted* / adverse effects
  • Surgery, Computer-Assisted* / instrumentation
  • Transcatheter Aortic Valve Replacement* / adverse effects
  • Transcatheter Aortic Valve Replacement* / instrumentation
  • Treatment Outcome

Supplementary concepts

  • Bicuspid Aortic Valve