The Impact of Size and Position of a Mechanical Expandable Transcatheter Aortic Valve: Novel Insights Through Computational Modelling and Simulation.
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.
['Rocatello|Giorgia|G|', 'El Faquir|Nahid|N|', 'de Backer|Ole|O|', 'Swaans|Martin J|MJ|', 'Latib|Azeem|A|', 'Vicentini|Luca|L|', 'Segers|Patrick|P|', 'De Beule|Matthieu|M|', 'de Jaegere|Peter|P|', 'Mortier|Peter|P|']
D001021:Aortic Valve D001022:Aortic Valve Insufficiency D001024:Aortic Valve Stenosis D001145:Arrhythmias, Cardiac D000066491:Clinical Decision-Making D005060:Europe D006350:Heart Valve Prosthesis D006439:Hemodynamics D006801:Humans D008955:Models, Cardiovascular D061330:Multidetector Computed Tomography D066230:Patient-Specific Modeling D011474:Prosthesis Design D018570:Risk Assessment D012307:Risk Factors D065467:Transcatheter Aortic Valve Replacement D016896:Treatment Outcome
Computer simulations Aortic regurgitation Conduction abnormalities Equivocal aortic root dimensions TAVI