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Journal of Cardiovascular Translational Research

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01-10-2019 | Transcatheter Aortic Valve Implantation | Original Article

The Impact of Size and Position of a Mechanical Expandable Transcatheter Aortic Valve: Novel Insights Through Computational Modelling and Simulation

Authors: Giorgia Rocatello, Nahid El Faquir, Ole de Backer, Martin J. Swaans, Azeem Latib, Luca Vicentini, Patrick Segers, Matthieu De Beule, Peter de Jaegere, Peter Mortier

Published in: Journal of Cardiovascular Translational Research | Issue 5/2019

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.

Leon, M. B., Smith, C. R., Mack, M. J., Makkar, R. R., Svensson, L. G., Kodali, S. K., et al. (2016). Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. New England Journal of Medicine, 374(17), 1609–1620. https://doi.org/10.1056/NEJMoa1514616.CrossRefPubMed

Siontis, G. C. M., Praz, F., Pilgrim, T., Mavridis, D., Verma, S., Salanti, G., et al. (2016). Transcatheter aortic valve implantation vs. surgical aortic valve replacement for treatment of severe aortic stenosis: a meta-analysis of randomized trials. European Heart Journal, 37(47), 3503–3512. https://doi.org/10.1093/eurheartj/ehw225.CrossRefPubMed

Smith, C. R., Leon, M. B., Mack, M. J., Miller, D. C., Moses, J. W., Svensson, L. G., et al. (2011). Transcatheter versus surgical aortic-valve replacement in high-risk patients. New England Journal of Medicine, 364(23), 2187–2198. https://doi.org/10.1056/NEJMoa1103510.CrossRefPubMed

Almeida, J. G., Ferreira, S. M., Fonseca, P., Dias, T., Guerreiro, C., Barbosa, A. R., et al. (2017). Association between implantation depth assessed by computed tomography and new-onset conduction disturbances after transcatheter aortic valve implantation. Journal of Cardiovascular Computed Tomography, 11(5), 332–337. https://doi.org/10.1016/j.jcct.2017.08.003.CrossRefPubMed

Husser, O., Pellegrini, C., Kessler, T., Burgdorf, C., Thaller, H., Mayr, N. P., et al. (2016). Predictors of permanent pacemaker implantations and new-onset conduction abnormalities with the SAPIEN 3 balloon-expandable transcatheter heart valve. JACC. Cardiovascular Interventions, 9(3), 244–254. https://doi.org/10.1016/j.jcin.2015.09.036.CrossRefPubMed

Blanke, P., Reinohl, J., Schlensak, C., Siepe, M., Pache, G., Euringer, W., et al. (2012). Prosthesis oversizing in balloon-expandable transcatheter aortic valve implantation is associated with contained rupture of the aortic root. Circulation. Cardiovascular Interventions, 5(4), 540–548. https://doi.org/10.1161/circinterventions.111.967349.CrossRefPubMed

Debry, N., Sudre, A., Elquodeimat, I., Delhaye, C., Schurtz, G., Bical, A., et al. (2016). Prognostic value of the ratio between prosthesis area and indexed annulus area measured by MultiSlice-CT for transcatheter aortic valve implantation procedures. Journal of Geriatric Cardiology, 13(6), 483–488. https://doi.org/10.11909/j.issn.1671-5411.2016.06.004. CrossRefPubMedPubMedCentral

Sherif, M. A., Abdel-Wahab, M., Stöcker, B., Geist, V., Richardt, D., Tölg, R., et al. (2010). Anatomic and procedural predictors of paravalvular aortic regurgitation after implantation of the Medtronic CoreValve bioprosthesis. Journal of the American College of Cardiology, 56(20), 1623–1629. https://doi.org/10.1016/j.jacc.2010.06.035.CrossRefPubMed

van der Boon, R. M., Houthuizen, P., Urena, M., Poels, T. T., van Mieghem, N. M., Brueren, G. R., et al. (2015). Trends in the occurrence of new conduction abnormalities after transcatheter aortic valve implantation. Catheterization and Cardiovascular Interventions, 85(5), E144–E152. https://doi.org/10.1002/ccd.25765.CrossRefPubMed

10.

Cerillo, A. G., Mariani, M., Berti, S., & Glauber, M. (2012). Sizing the aortic annulus. Annals of Cardiothoracic Surgery, 1(2), 245–256. https://doi.org/10.3978/j.issn.2225-319X.2012.06.13. CrossRefPubMedPubMedCentral

11.

Capelli, C., Bosi, G. M., Cerri, E., Nordmeyer, J., Odenwald, T., Bonhoeffer, P., et al. (2012). Patient-specific simulations of transcatheter aortic valve stent implantation. Medical & Biological Engineering & Computing, 50(2), 183–192. https://doi.org/10.1007/s11517-012-0864-1.CrossRef

12.

McGee, O. M., Gunning, P. S., McNamara, A., & McNamara, L. M. (2018). The impact of implantation depth of the Lotus valve on mechanical stress in close proximity to the bundle of His. Biomechanics and Modeling in Mechanobiology. https://doi.org/10.1007/s10237-018-1069-9.CrossRefPubMed

13.

Auricchio, F., Conti, M., Morganti, S., & Reali, A. (2014). Simulation of transcatheter aortic valve implantation: a patient-specific finite element approach. Computer Methods in Biomechanics and Biomedical Engineering, 17(12), 1347–1357. https://doi.org/10.1080/10255842.2012.746676.CrossRefPubMed

14.

Morganti, S., Brambilla, N., Petronio, A. S., Reali, A., Bedogni, F., & Auricchio, F. (2016). Prediction of patient-specific post-operative outcomes of TAVI procedure: the impact of the positioning strategy on valve performance. Journal of Biomechanics, 49(12), 2513–2519. https://doi.org/10.1016/j.jbiomech.2015.10.048.CrossRefPubMed

15.

Bianchi, M., Marom, G., Ghosh, R. P., Fernandez, H. A., Taylor, J. R., Jr., Slepian, M. J., et al. (2016). Effect of balloon-expandable transcatheter aortic valve replacement positioning: a patient-specific numerical model. Artificial Organs, 40(12), E292–e304. https://doi.org/10.1111/aor.12806.CrossRefPubMedPubMedCentral

16.

Rocatello, G., El Faquir, N., De Santis, G., Iannaccone, F., Bosmans, J., De Backer, O., et al. (2018). Patient-specific computer simulation to elucidate the role of contact pressure in the development of new conduction abnormalities after catheter-based implantation of a self-expanding aortic valve. Circulation. Cardiovascular Interventions, 11(2), e005344. https://doi.org/10.1161/circinterventions.117.005344. CrossRefPubMed

17.

Bosmans, B., Famaey, N., Verhoelst, E., Bosmans, J., & Vander Sloten, J. (2016). A validated methodology for patient specific computational modeling of self-expandable transcatheter aortic valve implantation. Journal of Biomechanics, 49(13), 2824–2830. https://doi.org/10.1016/j.jbiomech.2016.06.024.CrossRefPubMed

18.

de Jaegere, P., De Santis, G., Rodriguez-Olivares, R., Bosmans, J., Bruining, N., Dezutter, T., et al. (2016). Patient-specific computer modeling to predict aortic regurgitation after transcatheter aortic valve replacement. JACC: Cardiovascular Interventions, 9(5), 508–512. https://doi.org/10.1016/j.jcin.2016.01.003.CrossRefPubMed

19.

Mao, W., Wang, Q., Kodali, S., & Sun, W. (2018). Numerical parametric study of paravalvular leak following a transcatheter aortic valve deployment into a patient-specific aortic root. Journal of Biomechanical Engineering, 140(10). https://doi.org/10.1115/1.4040457.

20.

Bianchi, M., Marom, G., Ghosh, R. P., Rotman, O. M., Parikh, P., Gruberg, L., et al. (2018). Patient-specific simulation of transcatheter aortic valve replacement: impact of deployment options on paravalvular leakage. Biomechanics and Modeling in Mechanobiology. https://doi.org/10.1007/s10237-018-1094-8.CrossRefPubMedPubMedCentral

21.

Schultz, C. J., Rodriguez-Olivares, R., Bosmans, J., Lefèvre, T., De Santis, G., Bruining, N., et al. (2016). Patient-specific image-based computer simulation for the prediction of valve morphology and calcium displacement after TAVI with the Medtronic CoreValve and the Edwards SAPIEN valve. EuroIntervention, 11(9), 1044–1052. https://doi.org/10.4244/EIJV11I9A212.CrossRefPubMed

22.

Bailey, J., Curzen, N., & Bressloff, N. W. (2016). Assessing the impact of including leaflets in the simulation of TAVI deployment into a patient-specific aortic root. Computer Methods in Biomechanics and Biomedical Engineering, 19(7), 733–744. https://doi.org/10.1080/10255842.2015.1058928.CrossRefPubMed

23.

Finotello, A., Morganti, S., & Auricchio, F. (2017). Finite element analysis of TAVI: impact of native aortic root computational modeling strategies on simulation outcomes. Medical Engineering & Physics, 47, 2–12. https://doi.org/10.1016/j.medengphy.2017.06.045.CrossRef

24.

Sinning, J. M., Stundl, A., Pingel, S., Weber, M., Sedaghat, A., Hammerstingl, C., et al. (2016). Pre-procedural hemodynamic status improves the discriminatory value of the aortic regurgitation index in patients undergoing transcatheter aortic valve replacement. JACC. Cardiovascular Interventions, 9(7), 700–711. https://doi.org/10.1016/j.jcin.2015.12.271.CrossRefPubMed

25.

Sellers, R. D., Levy, M. J., Amplatz, K., & Lillehei, C. W. (1964). Left retrograde cardioangiography in acquired cardiac disease: technic, indications and interpretations in 700 cases. The American Journal of Cardiology, 14, 437–447.CrossRefPubMed

26.

van Gils, L., Wohrle, J., Hildick-Smith, D., Bleiziffer, S., Blackman, D. J., Abdel-Wahab, M., et al. (2018). Importance of contrast aortography with lotus transcatheter aortic valve replacement: a post hoc analysis from the RESPOND Post-Market Study. JACC. Cardiovascular Interventions, 11(2), 119–128. https://doi.org/10.1016/j.jcin.2017.10.016.CrossRefPubMed

27.

Youden, W. J. (1950). Index for rating diagnostic tests. Cancer, 3(1), 32–35.CrossRefPubMed

28.

Blackman, D. J., Meredith, I. T., Dumonteil, N., Tchetche, D., Hildick-Smith, D., Spence, M. S., et al. (2017). Predictors of paravalvular regurgitation after implantation of the fully repositionable and retrievable lotus transcatheter aortic valve (from the REPRISE II trial extended cohort). The American Journal of Cardiology, 120(2), 292–299. https://doi.org/10.1016/j.amjcard.2017.04.026.CrossRefPubMed

29.

Fujita, B., Kutting, M., Seiffert, M., Scholtz, S., Egron, S., Prashovikj, E., et al. (2016). Calcium distribution patterns of the aortic valve as a risk factor for the need of permanent pacemaker implantation after transcatheter aortic valve implantation. European Heart Journal Cardiovascular Imaging, 17(12), 1385–1393. https://doi.org/10.1093/ehjci/jev343.CrossRefPubMed

30.

Kawashima, T., & Sasaki, H. (2011). Gross anatomy of the human cardiac conduction system with comparative morphological and developmental implications for human application. Annals of Anatomy, 193(1), 1–12. https://doi.org/10.1016/j.aanat.2010.11.002.CrossRefPubMed

31.

Kawashima, T., & Sato, F. (2014). Visualizing anatomical evidences on atrioventricular conduction system for TAVI. International Journal of Cardiology, 174(1), 1–6. https://doi.org/10.1016/j.ijcard.2014.04.003.CrossRefPubMed

32.

Russ, C., Hopf, R., Hirsch, S., Sundermann, S., Falk, V., Szekely, G., et al. (2013). Simulation of transcatheter aortic valve implantation under consideration of leaflet calcification. Conference Proceedings: Annual International Conference of the IEEE Engineering in Medicine and Biology Society, 2013, 711–714. https://doi.org/10.1109/embc.2013.6609599.CrossRef

Title: The Impact of Size and Position of a Mechanical Expandable Transcatheter Aortic Valve: Novel Insights Through Computational Modelling and Simulation
Authors: Giorgia Rocatello
Nahid El Faquir
Ole de Backer
Martin J. Swaans
Azeem Latib
Luca Vicentini
Patrick Segers
Matthieu De Beule
Peter de Jaegere
Peter Mortier
Publication date: 01-10-2019
Publisher: Springer US
Keyword: Transcatheter Aortic Valve Implantation
Published in: Journal of Cardiovascular Translational Research / Issue 5/2019
Print ISSN: 1937-5387
Electronic ISSN: 1937-5395
DOI: https://doi.org/10.1007/s12265-019-09877-2

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The Impact of Size and Position of a Mechanical Expandable Transcatheter Aortic Valve: Novel Insights Through Computational Modelling and Simulation

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