Cardiovascular magnetic resonance assessment of 1st generation CoreValve and 2nd generation Lotus valves

Musa, Tarique A; Uddin, Akhlaque; Dobson, Laura E; Swoboda, Peter; Garg, Pankaj; Foley, James R.; Malkin, Christopher J.; Plein, Sven; Blackman, Daniel J.; Greenwood, John P

doi:10.1111/joic.12512

Cited by 6 publications

(2 citation statements)

References 48 publications

(103 reference statements)

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“…Recently, multi-modality imaging, i.e. conventional CT combined with cardiac magnetic resonance, has demonstrated useful for pre 43 and post-TAVI evaluation, especially to quantify residual aortic regurgitation 44 .…”

Section: Discussionmentioning

confidence: 99%

A validated computational framework to predict outcomes in TAVI

Bosi

Capelli

Cheang

et al. 2020

Sci Rep

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transcatheter aortic valve implantation (tAVi) still presents complications: paravalvular leakage (pVL) and onset of conduction abnormalities leading to permanent pacemaker implantation. Our aim was testing a validated patient-specific computational framework for prediction of TAVI outcomes and possible complications. Twenty-eight TAVI patients (14 SapienXT and 14 CoreValve) were retrospectively selected. Pre-procedural CT images were post-processed to create 3D patientspecific implantation sites. The procedures were simulated with finite element analysis. Simulations' results were compared against post-procedural clinical fluoroscopy and echocardiography images. The computational model was in good agreement with clinical findings: the overall stent diameter difference was 2.6% and PVL was correctly identified with a post-processing algorithm in 83% of cases. Strains in the implantation site were studied to assess the risk of conduction system disturbance and were found highest in the patient who required pacemaker implantation. this study suggests that computational tool could support safe planning and broadening of tAVi. Transcatheter aortic valve implantation (TAVI) is an established treatment for patients with severe aortic stenosis (AS) who are deemed unsuitable for surgery 1-5. Since the first-in-man implantation in 2002 6 , TAVI technology has experienced a tremendous amount and pace of progress, thanks to developments in pre-procedural imaging assessment, operator experience, and engineering device research 7 , so that a treatment that was designed for high-risk patients only, is now shifting toward lower surgical risk case applications 8,9 with many companies presenting innovative valved stent designs to overcome most of the limitations of the first-generation TAVI devices 5,7,10. However, TAVI still presents complications, mainly related to device sizing and positioning. If oversized, the TAVI device might cause vascular injury, such as aortic dissection, perforation or rupture of the aortic annulus; 11,12 if undersized, it may present anchoring problems, embolization and paravalvular leakage (PVL), reported in 65-89% of cases 13,14. Conduction abnormalities commonly (12-35%) occur following TAVI 15-18 , leading to the need of permanent pacemaker (PPM) implantation, more frequently required with self-expandable devices (28% vs. 6% of balloon-expandable choices) 19 likely due to their material properties and larger sizes resulting in higher forces applied to the adjacent native conduction system 1,18,20. These complications highlight the importance of accurate interventional planning, appropriate device choice and correct patient selection. In this context, computational simulations, an already established tool to support engineering device development, could be useful, if integrated with a patient-specific approach, to support clinical decision making and introduce new technologies in clinical practice. Despite increasing acknowledgement of the usefulness of patient-specific computational modelling from...

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Section: Discussionmentioning

confidence: 99%

A validated computational framework to predict outcomes in TAVI

Bosi

Capelli

Cheang

et al. 2020

Sci Rep

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“…A recent meta-analysis that included 305 patients who completed pre-and post-TAVI CMR showed a significant reduction in left ventricular end diastolic volume (median reduction of 4 ml/m 2 ), left ventricular end systolic volume (median reduction of 5 ml/m 2 ), left ventricular mass index (median reduction of 15.1 g/m 2 ), and increased LV ejection fraction (median increase of 3.4%) within six months after TAVI (50). Such reverse remodelling is similar for SAVR and TAVI (the first and second generation) (51).…”

Section: Cine Short-axis View For Left Ventricular Reverse Remodellingmentioning

confidence: 90%

Is there a role for cardiovascular magnetic resonance imaging in the assessment of biological aortic valves?

Vermes,

Iacuzio,

Maréchaux

et al. 2023

Front. Cardiovasc. Med.

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Patients with biological aortic valves (following either surgical aortic valve replacement [SAVR] or trans catheter aortic valve implantation [TAVI]) require lifelong follow-up with an imaging modality to assess prosthetic valve function and dysfunction. Echocardiography is currently the first-line imaging modality to assess biological aortic valves. In this review, we discuss the potential role of cardiac magnetic resonance imaging (CMR) as an additional imaging modality in situations of inconclusive or equivocal echocardiography. Planimetry of the prosthetic orifice can theoretically be measured, as well as the effective orifice area, with potential limitations, such as CMR valve-related artefacts and calcifications in degenerated prostheses. The true benefit of CMR is its ability to accurately quantify aortic regurgitation (paravalvular and intra-valvular) with a direct and reproducible method independent of regurgitant jet morphology to accurately assess reverse remodelling and non-invasively detect focal and interstitial diffuse myocardial fibrosis. Following SAVR or TAVI for aortic stenosis, interstitial diffuse fibrosis can regress, accompanied by structural and functional improvement that CMR can accurately assess.

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Network meta-analysis of new-generation valves for transcatheter aortic valve implantation

et al. 2019

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Cardiovascular magnetic resonance assessment of 1st generation CoreValve and 2nd generation Lotus valves

Abstract: Immediately post-TAVR, there was significantly less AR but a higher residual peak pressure gradient with the Lotus valve compared to CoreValve. However, at 6 months both devices had comparable valve hemodynamics and LV reverse remodeling.

Cited by 6 publications

References 48 publications

A validated computational framework to predict outcomes in TAVI

A validated computational framework to predict outcomes in TAVI

Is there a role for cardiovascular magnetic resonance imaging in the assessment of biological aortic valves?

Network meta-analysis of new-generation valves for transcatheter aortic valve implantation

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