1. Patient-Specific Computer Simulation in TAVR With the Self-Expanding Evolut R Valve
- Author
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Valérie Collas, Nahid El Faquir, Paul Cummins, Nicola Buzzatti, Gintautas Bieliauskas, Lars Søndergaard, Herbert Kroon, Ben Ren, Joana Maria Ribeiro, Ole De Backer, Zouhair Rahhab, Quinten Wolff, Nicolas M. Van Mieghem, Johan Bosmans, Mattie J. Lenzen, Peter de Jaegere, Azeem Latib, Matti Adam, Tanja K. Rudolph, Hendrik Wienemann, Davide Schiavi, and Cardiology
- Subjects
Male ,Patient-Specific Modeling ,medicine.medical_specialty ,Transcatheter aortic ,medicine.medical_treatment ,Aortic Valve Insufficiency ,Clinical Decision-Making ,Regurgitation (circulation) ,030204 cardiovascular system & hematology ,Prosthesis Design ,Severity of Illness Index ,Transcatheter Aortic Valve Replacement ,03 medical and health sciences ,0302 clinical medicine ,Valve replacement ,Predictive Value of Tests ,Internal medicine ,Multidetector Computed Tomography ,Humans ,Medicine ,Prospective Studies ,Registries ,030212 general & internal medicine ,Aged ,Aged, 80 and over ,business.industry ,Models, Cardiovascular ,Aortic Valve Stenosis ,Patient specific ,medicine.disease ,Europe ,Stenosis ,Treatment Outcome ,Multicenter study ,Aortic Valve ,Heart Valve Prosthesis ,Paravalvular leakage ,Cardiology ,Female ,Observational study ,Human medicine ,Cardiology and Cardiovascular Medicine ,business - Abstract
OBJECTIVES The aim of this study was to assess the added value and predictive power of the TAVIguide (Added Value of Patient-Specific Computer Simulation in Transcatheter Aortic Valve Implantation) software in clinical practice. BACKGROUND Optimal outcome after transcatheter aortic valve replacement (TAVR) may become more important as TAVR shifts toward low-risk patients. Patient-specific computer simulation is able to provide prediction of outcome after TAVR. Its clinical role and validation of accuracy, however, have not yet been studied prospectively. METHODS A prospective, observational, multicenter study was conducted among 80 patients with severe aortic stenosis treated with the Evolut R valve. Simulation was performed in 42 patients and no simulation in 38. A comparison between the valve size (decision 1) and target depth of implantation selected by the operator on the basis of multislice computed tomography and the valve size (decision 2) and target depth of implantation selected after simulation were the primary endpoints. Predictive power was examined by comparing the simulated and observed degree of aortic regurgitation. RESULTS Decision 2 differed from decision 1 in 1 of 42 patients because of predicted paravalvular leakage, and changes in valve type occurred in 2 of 42. In 39 of 42 patients, decisions 1 and 2 were similar. Target depth of implantation differed in 7 of 42 patients after simulation (lower in 4 and higher in 3). In 16 of 42 patients, simulation affected the TAVR procedure; in 9, the operator avoided additional measures to achieve the target depth of implantation, and in 7 patients, additional measures were performed. There was a trend toward a higher degree of predicted than observed aortic regurgitation (17.5 vs. 12 ml/s; p = 0.13). CONCLUSIONS Patient-specific computer simulation did not affect valve size selection but did affect the selection of the target depth of implantation and the execution of TAVR to achieve the desired target depth of implantation. (c) 2020 by the American College of Cardiology Foundation.
- Published
- 2020