Caterina Gandolfo1, Valentina Agnese1, Diego Bellavia1, Giovanni Gentile1, Giuseppe M. Raffa1, Giuseppe Romano1, Francesco Clemenza1, Michele Pilato1, Salvatore Pasta1,2,31Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
2Fondazione Ri.MED, Palermo, Italy
3Electronic correspondence: email@example.com
Background and aim of the study: Patients with bicuspid aortic valve (BAV) are conventionally excluded from transcatheter aortic valve implantation (TAVI) because of potential difficulties in expanding the prosthetic device correctly. The details are presented of a numerical study of TAVI using the Edwards SAPIEN 3 (S3) transcatheter heart valve in a BAV patient with severe stenosis.
Methods: A simulation strategy included a patient-specific aortic anatomy of aortic root, calcifications and BAV leaflets extracted from medical imaging analyses, and realistic crimping and deployment modeling of the S3 frame in the BAV patient.
Results: Tissue stress analysis revealed a non-uniform stress distribution in the aortic wall characterized by local
maxima in the contact area of the inner aortic layer with either the S3 frame or calcific p laques. Deployment simulation determined a good apposition of S3 characterized by a negligible gap (area of 4.1 mm2) that did not cause paravalvular leak, as confirmed by functional echocardiographic evaluation.
Conclusion: The present study provided a further step towards the use of computational simulations for virtual planning of TAVI. The aim was to improve not only the efficacy of the implantation but also the exploration of ‘off-label’ applications such as TAVI for BAV patients.Video 1: Simulation of the TAVI procedure.
The Journal of Heart Valve Disease 2018;27:147-150
|Modeling Transcatheter Aortic Valve Implantation in a Bicuspid Aortic Valve Patient|
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