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

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 contraindication 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.

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

“…One potential solution for identifying patients whose anatomy may not be suitable for TAVR, is patient-specific computer simulation. This technology has been well--13-validated in the trileaflet cohort (9-11) with encouraging early validation in BAV patients (19)(20)(21).…”

Transcatheter Heart Valve Implantation in Bicuspid Patients with Self-Expanding Device

“…A similar study showed optimal conformability to the elliptical BAV anatomy with both the Lotus and ACURATE THVs [26]. In a single center study focused on n.7 bicuspid patients, Brouwer et al [27] demonstrated the TAVI outcome with the self-expanding Evolut Pro THV and suggested that simulations can improve the procedural outcome in the challenging bicuspid population. In our previous investigation [28], we assessed the efficacy and safety of TAVI in a cohort of n.8 patients with stenotic BAV who underwent TAVI with the balloon-expandable SAPIEN 3 Ultra device.…”

New Insights into Valve Hemodynamics

“…The company then reconstructs the cardiac anatomy, generates and runs the finite element analysis and CFD simulations, and provides a report on the results of several scenarios within two working days. Since the first presentation of this tool, numerous studies have demonstrated its clinical usage including for implantation in bicuspid aortic valves, [71][72][73] and the use of TAVI in the mitral location with native calcified valves 74,75 and inside a failed bioprosthetic valve. 76 Use of the FEops HEARTguide has also been expanded to additional TAVI devices, 77 device optimization, 78 and also for procedural recommendations based on additional possible complications, such as conduction abnormalities.…”