Ongoing Experience With Patient-Specific Computer Simulation of Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve

Cameron Dowling; Robert Gooley; Liam McCormick; Rahul P Sharma; Alan C Yeung; William F Fearon; James Dargan; Faisal Khan; Sami Firoozi; Stephen J Brecker

doi:10.1016/j.carrev.2023.01.015

Ongoing Experience With Patient-Specific Computer Simulation of Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve

Cardiovasc Revasc Med. 2023 Jun:51:31-37. doi: 10.1016/j.carrev.2023.01.015. Epub 2023 Jan 24.

Authors

Affiliations

¹ Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia. Electronic address: [email protected].
² MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
³ Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA.
⁴ Cardiology Clinical Academic Group, St. George's University of London and St. George's University Hospitals NHS Foundation Trust, London, United Kingdom.

PMID: 36740551
DOI: 10.1016/j.carrev.2023.01.015

Abstract

Background: Transcatheter aortic valve replacement (TAVR) is increasingly being used to treat younger, lower-risk patients with bicuspid aortic valve (BAV). Patient-specific computer simulation may identify patients at risk for developing paravalvular regurgitation (PVR) and major conduction disturbance. Only limited prospective experience of this technology exist. We wished to describe our ongoing experience with patient-specific computer simulation.

Methods: Patients who were referred for consideration of TAVR with a self-expanding transcatheter heart valve (THV) and had BAV identified on pre-procedural cardiac computed tomography imaging underwent patient-specific computer simulation. The computer simulations were reviewed by the Heart Team and used to guide surgical or transcatheter treatment approaches and to aid in THV sizing and positioning. Clinical outcomes were recorded.

Results: Between May 2019 and May 2021, 16 patients with BAV were referred for consideration of TAVR with a self-expanding THV. Sievers Type 1 morphology was present in 15 patients and Type 0 in the remaining patient. Two patients were predicted to develop moderate-to-severe PVR with a TAVR procedure and these patients underwent successful surgical aortic valve replacement. In the remaining 14 patients, computer simulation was used to optimize THV sizing and positioning to minimise PVR and conduction disturbance. One patient with a low valve implantation depth developed moderate PVR and this complication was correctly predicted by the computer simulations. No patient required insertion of a new permanent pacemaker.

Conclusion: Patient-specific computer simulation may be used to guide the most appropriate treatment modality for patients with BAV. The usage of computer simulation to guide THV sizing and positioning was associated with favourable clinical outcomes.

Keywords: Aortic valve stenosis; Bicuspid aortic valve; Computer simulation; Finite element analysis; Heart valve prosthesis implantation; Transcatheter aortic valve replacement.

MeSH terms

Aortic Valve / diagnostic imaging
Aortic Valve / surgery
Aortic Valve Stenosis* / diagnostic imaging
Aortic Valve Stenosis* / etiology
Aortic Valve Stenosis* / surgery
Bicuspid Aortic Valve Disease* / etiology
Bicuspid Aortic Valve Disease* / surgery
Computer Simulation
Heart Valve Diseases* / diagnostic imaging
Heart Valve Diseases* / surgery
Heart Valve Prosthesis*
Humans
Multidetector Computed Tomography
Prospective Studies
Prosthesis Design
Transcatheter Aortic Valve Replacement* / adverse effects
Transcatheter Aortic Valve Replacement* / methods
Treatment Outcome