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JACC Cardiovasc Imaging. 2017 Jul;10(7):719-731. doi: 10.1016/j.jcmg.2017.04.005.

Quantitative Prediction of Paravalvular Leak in Transcatheter Aortic Valve Replacement Based on Tissue-Mimicking 3D Printing.

Author information

1
Department of Cardiovascular Imaging, Piedmont Heart Institute, Atlanta, Georgia; Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia. Electronic address: zhen.qian@piedmont.org.
2
H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia; Georgia Tech Manufacturing Institute, Georgia Institute of Technology, Atlanta, Georgia.
3
Department of Cardiovascular Imaging, Piedmont Heart Institute, Atlanta, Georgia; Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia.
4
Department of Cardiology, Chinese PLA General Hospital, Beijing, China.
5
Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia.
6
Georgia Tech Manufacturing Institute, Georgia Institute of Technology, Atlanta, Georgia; School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia.
7
H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia; Georgia Tech Manufacturing Institute, Georgia Institute of Technology, Atlanta, Georgia; School of Materials Science and Engineering, Georgia Institute of Technology, Atlanta, Georgia.
8
Department of Cardiovascular Imaging, Piedmont Heart Institute, Atlanta, Georgia.

Abstract

OBJECTIVES:

This study aimed to develop a procedure simulation platform for in vitro transcatheter aortic valve replacement (TAVR) using patient-specific 3-dimensional (3D) printed tissue-mimicking phantoms. We investigated the feasibility of using these 3D printed phantoms to quantitatively predict the occurrence, severity, and location of any degree of post-TAVR paravalvular leaks (PVL).

BACKGROUND:

We have previously shown that metamaterial 3D printing technique can be used to create patient-specific phantoms that mimic the mechanical properties of biological tissue. This may have applications in procedural planning for cardiovascular interventions.

METHODS:

This retrospective study looked at 18 patients who underwent TAVR. Patient-specific aortic root phantoms were created using the tissue-mimicking 3D printing technique using pre-TAVR computed tomography. The CoreValve (self-expanding valve) prostheses were deployed in the phantoms to simulate the TAVR procedure, from which post-TAVR aortic root strain was quantified in vitro. A novel index, the annular bulge index, was measured to assess the post-TAVR annular strain unevenness in the phantoms. We tested the comparative predictive value of the bulge index and other known predictors of post-TAVR PVL.

RESULTS:

The maximum annular bulge index was significantly different among patient subgroups that had no PVL, trace-to-mild PVL, and moderate-to-severe PVL (p = 0.001). Compared with other known PVL predictors, bulge index was the only significant predictor of moderate-severe PVL (area under the curve = 95%; p < 0.0001). Also, in 12 patients with post-TAVR PVL, the annular bulge index predicted the major PVL location in 9 patients (accuracy = 75%).

CONCLUSIONS:

In this proof-of-concept study, we have demonstrated the feasibility of using 3D printed tissue-mimicking phantoms to quantitatively assess the post-TAVR aortic root strain in vitro. A novel indicator of the post-TAVR annular strain unevenness, the annular bulge index, outperformed the other established variables and achieved a high level of accuracy in predicting post-TAVR PVL, in terms of its occurrence, severity, and location.

KEYWORDS:

annular bulge index; aortic valve calcification; balloon post-dilation; computed tomography; echocardiography; strain

PMID:
28683947
DOI:
10.1016/j.jcmg.2017.04.005
[Indexed for MEDLINE]
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