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You are here: Contents > 2018-19 > Volume 28 Number 1 (2018-19) > AORTIC VALVE DISEASE > Effect of Commissural Alignment on Paravalvular Aortic Regurgitation after TAVI

Effect of Commissural Alignment on Paravalvular Aortic Regurgitation after TAVI

Valérie M. Collas1, Giorgia Rocatello2, Nahid El Faquir3, Bernard Paelinck1, Gianluca De Santis4, Tim Dezutter4, Patrick Segers2, Matthieu De Beule2,4, Peter Mortier4, Peter de Jaegere3, Johan Bosmans1

1Department of Cardiology, Antwerp University Hospital, Edegem, Belgium
2IBiTech-bioMMeda, Ghent University, Ghent, Belgium
3Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands
4FEops NV, Ghent, Belgium

Background and aim of the study: Patient-specific computer simulation can be used to accurately predict postoperative aortic regurgitation (AR), and allow an assessment of the impact of changes on valve performance. The study aim was to assess whether alignment of the bioprosthetic leaflets of a transcatheter heart valve with those of the native aortic valve plays a role in the occurrence of AR after transcatheter aortic valve implantation (TAVI), using patient-specific computer simulation.

Methods: In 63 patients who had undergone TAVI with the self-expanding CoreValve, the TAVI procedure was simulated using patient-specific computer simulation. Both, alignment and non-alignment of the native and bioprosthetic leaflets was simulated in all patients. Computer model accuracy was assessed by comparing predicted (mean of aligned and non-aligned simulation)

 

and observed AR (angiography, transthoracic echocardiography).

Results: Predicted AR was significantly higher in patients with AR grade II-III in comparison to patients with AR grade 0-I, based on angiography (16.5 [10.8-26.1] versus 10.8 [5.8-16.7] ml/s, p = 0.049) and echocardiography (23.2 [15.2-45.6] versus 11.8 [5.4-16.4] ml/s, p = 0.002). In case of non-alignment, predicted AR was higher in 70% of the patients (13.2 [6.9-21.5] versus 11.8 [6.7-19.0] ml/s, p <0.001) in comparison to an aligned position of the bioprosthesis.

Conclusion: Patient-specific computer simulation can accurately predict the degree of AR after TAVI. Alignment of the bioprosthesis affects the degree of AR, although the absolute difference is small and may, therefore, not play a clinically relevant role.

The Journal of Heart Valve Disease 2018-19;28:1-7

Effect of Commissural Alignment on Paravalvular Aortic Regurgitation after TAVI

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