Differences in clinical valve size selection and valve size selection for patient-specific computer simulation in transcatheter aortic valve replacement (TAVR): a retrospective multicenter analysis

AbstractValve size selection for transcatheter aortic valve replacement (TAVR) is currently based on cardiac CT-scan. At variance with patient-specific computer simulation, this does not allow the assessment of the valve-host interaction. We aimed to compare clinical valve size selection and valve size selection by an independent expert for computer simulation. A multicenter retrospective analysis of valve size selection by the physician and the independent expert in 141 patients who underwent TAVR with the self-expanding CoreValve or Evolut R. Baseline CT-scan was used for clinical valve size selection and for patient-specific computer simulation. Simulation results were not available for clinical use. Overall true concordance between clinical and simulated valve size selection was observed in 47 patients (33%), true discordance in 15 (11%) and ambiguity in 79 (56%). In 62 (44%, cohort A) one valve size was simulated whereas two valve sizes were simulated in 79 (56%, cohort B). In cohort A, concordance was 76% and discordance was 24%; a smaller valve size was selected for simulation in 10 patients and a larger in 5. In cohort B, a different valve size was selected for simulation in all patients in addition to the valve size that was used for TAVR. The different valve size concerned a smaller valve in 45 patients (57%) and a larger in 34 (43%). Selection of the valve size differs between the physician and the independent computer simulation expert who used the same source of ...
Source: The International Journal of Cardiovascular Imaging - Category: Radiology Source Type: research

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This study sought to derive and validate a systematic method enabling AVC quantification using computed tomography angiography (CTA) in patients with AS.Methods134 consecutive patients with AS who underwent both NCCT and CTA were included in the study and sub-divided into derivation (n=71) and validation cohorts (n=63). On NCCT, AVC was quantified using Agatston method utilizing the software developed for semi-automatic assessment of coronary calcium. On CTA, mean contrast attenuation of aorta (AortaHU) and standard deviation (SD) was measured in the region-of-interest at level of sinotubular junction.ResultsUsing an adjus...
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
ConclusionLow-CM third-generation-DSCT achieves good IQ in TAVR candidates with CKD, and seems safe, with no apparent renal function deterioration or prevalence of PC-AKI. However, standard-CM protocols in non-CKD patients provide higher measurement reproducibility. Low-CM protocols should therefore be reserved for patients at high risk for PC-AKI.
Source: European Journal of Radiology - Category: Radiology Source Type: research
CONCLUSIONS: A tortuous abdominal aorta was found to be a predictor of the occurrence of a complication in patients undergoing transfemoral transcatheter aortic valve replacement. This computed tomography variable should therefore be taken into account when choosing the approach, especially for patients at intermediate and low surgical risk. PMID: 31732445 [PubMed - as supplied by publisher]
Source: Archives of Cardiovascular Diseases - Category: Cardiology Authors: Tags: Arch Cardiovasc Dis Source Type: research
Transcatheter aortic root repair (TARR) is still not available because of the complex anatomy. In order to develop future TARR technologies, a human-derived bench test model is required before performing animal tests. For this purpose, we aimed to validate computed tomography (CT)-derived 3D-printed root models for TARR technologies. Four human CT-derived roots were printed using different resins: Visijet M3 Crystal, Photopolymer gel SUP705, Formlabs flexible resin, and Materialise HeartPrint Flex. A stress test was performed using a 26-mm balloon-expandable Sapien valve deployed in aortic position. The too rigid Visijet M...
Source: ASAIO Journal - Category: Medical Devices Tags: Clinical Cardiovascular Source Type: research
Saranas, a Houston, Texas firm, is releasing its novel Early Bird bleeding monitoring system in the United States, following FDA de novo approval of the device. Intended for use during minimally invasive vascular procedures, the Early Bird helps ...
Source: Medgadget - Category: Medical Devices Authors: Tags: Cardiac Surgery Cardiology Radiology Vascular Surgery Source Type: blogs
CONCLUSIONS: AAD does not appear to impact the mid-term outcomes in a cohort of subjects undergoing TAVI. PMID: 31522139 [PubMed - as supplied by publisher]
Source: The Journal of Invasive Cardiology - Category: Cardiology Tags: J Invasive Cardiol Source Type: research
ConclusionsAscending aortic stent placement for ascending aortic disease is feasible and is associated with favorable aortic remodeling. Despite persistent perfusion to the false lumen in a subset of patients, there is minimal aortic dilation at short-term follow-up with excellent survival.
Source: The Annals of Thoracic Surgery - Category: Cardiovascular & Thoracic Surgery Source Type: research
CONCLUSIONS: Despite several prostheses available, most patients referred to Heart Valve Clinics and good candidate regarding their clinical profile cannot be implanted with TMVR because of mismatch between their anatomy and prosthesis characteristics. Our findings suggest the need to develop new prosthesis adapted to larger MA but with lower impact on the LVOT. PMID: 31449044 [PubMed - as supplied by publisher]
Source: EuroIntervention - Category: Cardiovascular & Thoracic Surgery Tags: EuroIntervention Source Type: research
This study aims to develop refined computational models simulating the deployments of Evolut R and PRO TAVR devices in a representative calcified BAV. The paravalvular leakage (PVL) was also calculated by computational fluid dynamics simulations. Computed tomography scan of severely stenotic BAV patient was acquired. The 3D calcium deposits were generated and embedded inside a parametric model of the BAV. Deployments of the Evolut R and PRO inside the calcified BAV were simulated in five bioprosthesis leaflet orientations. The hypothesis of asymmetric and elliptic stent deployment was confirmed. Positioning the bioprosthes...
Source: Medical and Biological Engineering and Computing - Category: Biomedical Engineering Source Type: research
We report a case of a 57-year-old female with dextrocardia and a solitary kidney. A patch aortoplasty for isthmic aortic coarctation repair was performed 40  years before when she was admitted to our department for dyspnea. Computed tomography scan showed a giant and saccular 10-cm diameter patch false aneurysm. The ascending aortic diameter was 34 mm and the echocardiography confirmed a severe aortic regurgitation of a bicuspid aortic valve. We decid ed to perform a 2-step approach: biologic aortic valve and ascending aorta replacement with total debranching of the epiaortic vessels and thoracic endovascular ane...
Source: Annals of Vascular Surgery - Category: Surgery Authors: Tags: Case Report Source Type: research
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