Computer simulated "Virtual TAVR" to guide TAVR in the presence of a previous Starr-Edwards mitral prosthesis

J Cardiovasc Comput Tomogr. 2019 Jan-Feb;13(1):38-40. doi: 10.1016/j.jcct.2018.09.009. Epub 2018 Oct 9.

Abstract

Background: We evaluated the utility of the HeartNavigator III software (Philips Healthcare, Netherlands) to create a patient specific three-dimensional model using ECG-gated CT images to plan Transcatheter Aortic Valve Replacement (TAVR) in a patient with previous Starr-Edwards mitral prosthesis.

Methods: A patient with a previous Starr-Edwards mitral prosthesis considered too high risk for conventional surgery required TAVR. It was uncertain whether this would be possible whilst avoiding the complication of the aortic prosthesis interacting with the high-profile Starr-Edwards cage and ball valve mechanism. To ensure it would be feasible and aid in the planning of the procedure a patient specific three-dimensional model was created from ECG-gated CT images using HeartNavigator III software (Philips Healthcare, Netherlands).

Results: The patient specific model allowed simulated "virtual" TAVR implantations to be performed with different models and sizes of aortic prosthesis. These pre-implant simulations allowed a safe and feasible implant strategy to be chosen. The images were also co-registered with fluoroscopy to guide deployment.

Conclusion: Using a patient-specific CT simulation technique we performed TAVR with a high level of precision, achieving a clear margin between a Portico (Abbot Vascular, US) TAVR and the Starr-Edwards cage.

Keywords: Ball and cage; Computational simulation; Heart navigator; Portico; Starr-Edwards; TAVR.

Publication types

  • Case Reports

MeSH terms

  • Aged, 80 and over
  • Aortic Valve / diagnostic imaging
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery*
  • Aortic Valve Stenosis / diagnostic imaging
  • Aortic Valve Stenosis / physiopathology
  • Aortic Valve Stenosis / surgery*
  • Cardiac-Gated Imaging Techniques
  • Echocardiography, Transesophageal
  • Electrocardiography
  • Female
  • Heart Valve Prosthesis Implantation / instrumentation*
  • Heart Valve Prosthesis*
  • Humans
  • Imaging, Three-Dimensional
  • Mitral Valve / diagnostic imaging
  • Mitral Valve / physiopathology
  • Mitral Valve / surgery*
  • Multidetector Computed Tomography
  • Patient-Specific Modeling
  • Predictive Value of Tests
  • Prosthesis Design
  • Radiographic Image Interpretation, Computer-Assisted
  • Severity of Illness Index
  • Surgery, Computer-Assisted* / instrumentation
  • Transcatheter Aortic Valve Replacement / instrumentation
  • Transcatheter Aortic Valve Replacement / methods*
  • Treatment Outcome