Abstract 17507: Simulation of Transcatheter Aortic Valve Replacement and Assessment of Regurgitation in in-vitro Pulsatile Model With Patient-specific Anatomy
Introduction: Aortic regurgitation (AR) following transcatheter aortic valve replacement (TAVR) has been shown to be associated with increased mortality. However, regurgitant volume cannot be directly measured in clinical situation. We developed an in-vitro pulsatile circuit with patient-specific anatomical models for simulating the whole TAVR procedure and investigated the valve function depending on the hemodynamic conditions.
Methods: Five patients with severe degenerative aortic valve stenosis (AS), who were treated with a 23mm SAPIEN XT and had AR after TAVR, were selected for modeling. The entire aortic valve complex, thoracic aorta, and iliofemoral artery of each patient were created by using the gated CT DICOM data, the 3D printing technology, and the dipping technique with elastic materials. Calcification deposition around the annulus was replicated by mimicking elasticity. Each model was incorporated into pulsatile flow circuit. Then a 23 mm SAPEN XT was implanted via transfemoral access in the model. The hemodynamic data (stroke volume and heart rate) reported on the clinical echocardiogram after TAVR were replicated as the basal flow conditions for each patient. The stroke volume and regurgitant volume were measured in additional flow conditions.
Results: A 23mm SAPIEN XT was successfully implanted in all 3D models. All data is presented in the Table. The Implanted valve frame areas were consistent between patients and in-vitro models. The tendency for regurgitant volume was matched with clinical evaluation of each patient. Increased mean aortic pressure (mAP) significantly magnified regurgitant fraction in all models (mAP 60 mmHg: 15.6 ± 2.7%, mAP 80 mmHg: 24.1 ± 4.2%, mAP 100 mmHg: 36.4 ± 7.9%; P <0.001).
Conclusions: We demonstrated that patient-specific 3D models could be used for simulation of transfemoral procedure and quantitative evaluation for aortic regurgitation following of TAVR.
Author Disclosures: Y. Tanaka: None. Y. Aoyama: None. K. Obama: None. S. Sasuga: None. A. Takahashi: None. M. Umezu: None. S. Saito: None. K. Iwasaki: None.
- © 2016 by American Heart Association, Inc.