Catheterization and cardiovascular interventions : official journal of the Society for Cardiac Angiography & Interventions · 2026
Computed Tomography Derived Procedure Simulations for Redo Transcatheter Aortic Valve Replacement.
СтатьяНаблюдательное исследованиеМногоцентровое исследованиеВалидационное исследованиеПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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van den Dorpel Mark M P, de Backer Ole, Abdel-Wahab Mohamed, Beneduce Alessandro, Dumonteil Nicolas, Blackman Daniel J, Willemen Yannick, Dargan James, Poon Karl, Daemen Joost, de Assis Lucas Uchoa, van Niekerk Jenna, Kardys Isabella, Tchetche Didier, De Beule Matthieu, Jan Nuis Rutger, Rocatello Giorgia, Debusschere Nic, Mortier Peter, Van Mieghem Nicolas M
Аннотация
BACKGROUND: Transcatheter aortic valve (TAV) failure may require redo transcatheter aortic valve replacement (redo-TAVR). The multiple layers of metal after redo-TAVR may jeopardize coronary artery patency and accessibility and result in prosthesis-patient mismatch. Dedicated software may use multi-slice computed tomography (MSCT) imaging to simulate TAV deployment relative to the prior TAV and the individual's anatomy and predict coronary accessibility and TAV expansion.
AIM: We aimed to validate redo-TAVR simulations created in FEops HEARTguide.
METHODS: This multicenter observational study included redo-TAVR patients who had MSCT imaging available at baseline, after index-TAVR and after redo-TAVR. Patient-specific redo-TAVR simulations were created. Simulated valve-to-aorta distances (a proxy for coronary accessibility), neoskirt height, TAV expansion at multiple frame levels, and residual valve area after redo-TAVR were compared to follow-up MSCT.
RESULTS: Among 25 patients, HEARTguide simulations of valve-to-coronary (VTC) distance (left VTC 6.0 ± 2.2 vs. 6.4 ± 2.3 mm, ICC = 0.856, p < 0.001; right VTC 5.8 ± 1.9 vs. 5.6 ± 1.9 mm, ICC = 0.740, p < 0.001) showed good agreement while valve-to-sinotubular-junction (VTSTJ) distance showed moderate agreement with follow-up MSCT (left VTSTJ 2.5 ± 1.8 vs. 3.3 ± 1.8 mm, ICC = 0.614, p = 0.004; right VTSTJ 2.8 ± 1.8 vs. 2.9 ± 1.2 mm, ICC = 0.613, p = 0.003). Redo-TAVR frame expansion simulations (mean frame area 434.8 ± 141.6 vs. 401.6 ± 142.9 mm, ICC = 0.930, p < 0.001; 393.5 ± 63.2 vs. 383.1 ± 82.5 mm, ICC = 0.822, p < 0.001, respectively) and simulations of residual valve area after redo-TAVR showed good agreement for self-expanding and balloon-expandable TAV (407.8 ± 67.8 vs. 389.6 ± 50.4 mm, ICC = 0.837, p < 0.001; 358.0 ± 66.1 vs. 336.1 ± 79.9 mm, ICC = 0.823, p < 0.001).
CONCLUSIONS: In this pilot study, MSCT-derived simulations of redo-TAVR provided accurate insights into coronary accessibility, TAV expansion, and residual valve area.
AIM: We aimed to validate redo-TAVR simulations created in FEops HEARTguide.
METHODS: This multicenter observational study included redo-TAVR patients who had MSCT imaging available at baseline, after index-TAVR and after redo-TAVR. Patient-specific redo-TAVR simulations were created. Simulated valve-to-aorta distances (a proxy for coronary accessibility), neoskirt height, TAV expansion at multiple frame levels, and residual valve area after redo-TAVR were compared to follow-up MSCT.
RESULTS: Among 25 patients, HEARTguide simulations of valve-to-coronary (VTC) distance (left VTC 6.0 ± 2.2 vs. 6.4 ± 2.3 mm, ICC = 0.856, p < 0.001; right VTC 5.8 ± 1.9 vs. 5.6 ± 1.9 mm, ICC = 0.740, p < 0.001) showed good agreement while valve-to-sinotubular-junction (VTSTJ) distance showed moderate agreement with follow-up MSCT (left VTSTJ 2.5 ± 1.8 vs. 3.3 ± 1.8 mm, ICC = 0.614, p = 0.004; right VTSTJ 2.8 ± 1.8 vs. 2.9 ± 1.2 mm, ICC = 0.613, p = 0.003). Redo-TAVR frame expansion simulations (mean frame area 434.8 ± 141.6 vs. 401.6 ± 142.9 mm, ICC = 0.930, p < 0.001; 393.5 ± 63.2 vs. 383.1 ± 82.5 mm, ICC = 0.822, p < 0.001, respectively) and simulations of residual valve area after redo-TAVR showed good agreement for self-expanding and balloon-expandable TAV (407.8 ± 67.8 vs. 389.6 ± 50.4 mm, ICC = 0.837, p < 0.001; 358.0 ± 66.1 vs. 336.1 ± 79.9 mm, ICC = 0.823, p < 0.001).
CONCLUSIONS: In this pilot study, MSCT-derived simulations of redo-TAVR provided accurate insights into coronary accessibility, TAV expansion, and residual valve area.
Предметные рубрики MeSH
HumansAortic ValveMultidetector Computed TomographyPredictive Value of TestsAged, 80 and overFemaleHeart Valve ProsthesisTranscatheter Aortic Valve ReplacementAortic Valve StenosisPatient-Specific ModelingTreatment OutcomeMaleModels, CardiovascularReoperationAgedProsthesis DesignReproducibility of ResultsComputed Tomography AngiographyTime FactorsProsthesis FailureRadiographic Image Interpretation, Computer-Assisted