Background
Current imaging techniques may inadequately rule out coronary artery obstruction (CAO),
a potentially fatal complication during transcatheter aortic valve replacement (TAVR).
Advancements in three-dimensional (3D)-printing allow the development of models capable
of replicating cardiac anatomy and predicting CAO. We sought to simulate TAVR utilising
3D-printed cardiac models to improve CAO risk assessment and procedural safety.
Methods
Thirteen (13) patients with aortic stenosis at high-risk of CAO during TAVR were selected
for 3D-printed modelling. The relevant anatomy for TAVR was precisely reconstructed
with Materialise Heart Print-Flex (Materialse, Leuven, Belgium) technology. An appropriately
sized valve prosthesis was deployed in each 3D-model and coronary ostia assessed for
obstruction.
Results
Model-derived results were compared to clinical outcomes in 13 cases. One high-risk
case underwent TAVR resulting in left main obstruction and subsequent stenting. This
outcome was accurately predicted by the 3D-model simulation. Two (2) high-risk TAVR
cases were abandoned following transient CAO during balloon aortic valvuloplasty (BAV).
The 3D-model simulations correlated with these findings, demonstrating CAO either
by a calcium nodule or the native valve leaflet. In another two cases, BAV was uncertain,
however the 3D-simulation demonstrated patency and successful TAVR was undertaken.
In remaining cases, no obstruction was demonstrated in-vitro, and all underwent uncomplicated
TAVR.
Conclusions
In this proof-of-concept study, 3D-model TAVR simulation correlates well to clinical
outcomes. 3D-models of patients at high-risk of CAO may be utilised in pre-procedural
planning to accurately predict this complication. As lower-risk surgical cohorts are
considered for TAVR, 3D-models may minimise complications leading to safer patient
outcomes.
Keywords
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Article info
Publication history
Published online: March 29, 2022
Accepted:
January 13,
2022
Received in revised form:
November 6,
2021
Received:
September 6,
2021
Identification
Copyright
Crown Copyright © 2022 Published by Elsevier B.V. on behalf of Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). All rights reserved.
