Underfilled balloon-expandable transcatheter aortic valve implantation with ad hoc post-dilation: Pulsatile flow simulation using a patient-specific three-dimensional printing model

Masahiro Yamawaki, Kazuto Obama, Saeko Sasuga, Azuma Takahashi, Yoshiaki Ito, Mitsuo Umezu, Kiyotaka Iwasaki*

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)

Abstract

Background: Underfilled transcatheter aortic-valve implantation with ad hoc post-dilation is a therapeutic option for patients with borderline annuli to avoid acute complication. The effects of this technique on valve leaflet behavior, hydrodynamic performances, and paravalvular leakage (PVL) using patient-specific three-dimensional (3D) aortic-valve models were investigated. Methods and Results: A female octogenarian patient was treated with this technique by using a 23-mm Sapien-XT. Patient-specific models were constructed from pre-procedure computed tomography (CT) data. Change in aortic annulus areas during systolic/ diastolic phases and post-procedure stent areas were adjusted to those of the patient. The following was performed: (1) -3 cc initial and -2 cc underfilled post-dilation to the scale-down model by adjusting percent oversizing; and (2) -1 cc initial underfilling, nominal volume, and repeat nominal volume post-dilation using the patient-specific model. Underfilling was associated with higher %PVL. Observation using a high-speed camera revealed distorted leaflets after underfilled implantation, with a longer valve-closing time and smaller effective orifice areas, especially in the -3 cc underfilled implantation. Micro-CT analysis revealed that the transcatheter valves shifted to the opposite side of the large annulus calcification after post-dilation and reduced the malapposition there. Conclusions: Excessive underfilled implantation showed unacceptable acute hemodynamics. Abnormal leaflet motions after underfilled implantation raised concerns about durability. Flow simulations using patient-oriented 3D models could help to investigate hemodynamics, leaflet motions, and the PVL mechanism.

Original languageEnglish
Pages (from-to)461-470
Number of pages10
JournalCirculation Journal
Volume83
Issue number2
DOIs
Publication statusPublished - 2019 Feb

Keywords

  • Ad hoc post-dilation
  • Paravalvular leakage
  • Pulsatile flow simulation
  • Transcatheter aortic valve implantation
  • Underfilled implantation

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Fingerprint

Dive into the research topics of 'Underfilled balloon-expandable transcatheter aortic valve implantation with ad hoc post-dilation: Pulsatile flow simulation using a patient-specific three-dimensional printing model'. Together they form a unique fingerprint.

Cite this