Author + information
- Received April 26, 2019
- Revision received July 17, 2019
- Accepted July 23, 2019
- Published online October 16, 2019.
- Cameron Dowling, MBBS∗ (, )
- Sami Firoozi, MBBS (Hons) and
- Stephen J. Brecker, MD
- Cardiology Clinical Academic Group, St. George’s, University of London and St. George’s University Hospitals NHS Foundation Trust, London, United Kingdom
- ↵∗Address for correspondence:
Dr. Cameron Dowling, Cardiology Clinical Academic Group, St. George’s Hospital, Blackshaw Road, London SW17 0QT, United Kingdom.
Objectives The aim of this study was to prospectively evaluate the clinical use of patient-specific computer simulation of transcatheter aortic valve replacement (TAVR) in bicuspid aortic valve (BAV) morphology.
Background Patient-specific computer simulation of TAVR in BAV may predict important clinical outcomes, such as paravalvular regurgitation and conduction disturbance.
Methods Between May 2018 and April 2019, all patients who were referred for TAVR who had BAV identified on work-up cardiac multidetector computed tomographic imaging prospectively underwent patient-specific computer simulation with a self-expanding transcatheter heart valve (THV) using TAVIguide technology.
Results Nine patients were included in the study. Sievers classification was type 0 in 2 patients and type 1 in 7 patients. The simulations altered the treatment strategy in 8 patients (89%). The simulations suggested moderate to severe paravalvular regurgitation in 3 patients, who were referred for consideration of surgery. The remaining 6 patients underwent TAVR with a self-expanding THV. In 5 of these patients (83%), THV size and/or implantation depth was altered to minimize paravalvular regurgitation and/or conduction disturbance. In 1 patient, simulations suggested significant conduction disturbance after TAVR, and a permanent pacemaker was implanted before the procedure. Following treatment, all 9 patients had no to mild paravalvular regurgitation. The patient who had a pre-procedure permanent pacemaker implanted became pacing dependent, with underlying third-degree atrioventricular block.
Conclusions Patient-specific computer simulation of TAVR in BAV can be used to identify those patients where TAVR may be associated with unfavorable clinical outcomes. Patient-specific computer simulation may be useful to guide THV sizing and positioning for potential favorable clinical outcomes.
- aortic valve stenosis
- bicuspid aortic valve
- computer simulation
- finite element analysis
- heart valve prosthesis implantation
- transcatheter aortic valve replacement
Dr. Dowling has received grant support and speaking honoraria from Medtronic. Prof. Brecker has received grant support and speaking honoraria and has served as a consultant to Medtronic; and has served as a consultant to Boston Scientific and Abbott Vascular. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 26, 2019.
- Revision received July 17, 2019.
- Accepted July 23, 2019.
- 2019 American College of Cardiology Foundation
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