Department of Cardiovascular Imaging, Piedmont Heart Institute, Atlanta, Georgia; Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, Georgia.
H. Milton Stewart School of Industrial and Systems Engineering, Georgia Institute of Technology, Atlanta, Georgia; Georgia Tech Manufacturing Institute, Georgia Institute of Technology, Atlanta, Georgia.
JACC Cardiovasc Imaging. 2017 Jul;10(7):719-731. doi: 10.1016/j.jcmg.2017.04.005.
OBJECTIVES: This study aimed to develop a procedure simulation platform for in vitro transcatheter aortic valve replacement (TAVR) using patient-specific 3-dimensional (3D) printed tissue-mimicking phantoms. We investigated the feasibility of using these 3D printed phantoms to quantitatively predict the occurrence, severity, and location of any degree of post-TAVR paravalvular leaks (PVL). BACKGROUND: We have previously shown that metamaterial 3D printing technique can be used to create patient-specific phantoms that mimic the mechanical properties of biological tissue. This may have applications in procedural planning for cardiovascular interventions. METHODS: This retrospective study looked at 18 patients who underwent TAVR. Patient-specific aortic root phantoms were created using the tissue-mimicking 3D printing technique using pre-TAVR computed tomography. The CoreValve (self-expanding valve) prostheses were deployed in the phantoms to simulate the TAVR procedure, from which post-TAVR aortic root strain was quantified in vitro. A novel index, the annular bulge index, was measured to assess the post-TAVR annular strain unevenness in the phantoms. We tested the comparative predictive value of the bulge index and other known predictors of post-TAVR PVL. RESULTS: The maximum annular bulge index was significantly different among patient subgroups that had no PVL, trace-to-mild PVL, and moderate-to-severe PVL (p = 0.001). Compared with other known PVL predictors, bulge index was the only significant predictor of moderate-severe PVL (area under the curve = 95%; p < 0.0001). Also, in 12 patients with post-TAVR PVL, the annular bulge index predicted the major PVL location in 9 patients (accuracy = 75%). CONCLUSIONS: In this proof-of-concept study, we have demonstrated the feasibility of using 3D printed tissue-mimicking phantoms to quantitatively assess the post-TAVR aortic root strain in vitro. A novel indicator of the post-TAVR annular strain unevenness, the annular bulge index, outperformed the other established variables and achieved a high level of accuracy in predicting post-TAVR PVL, in terms of its occurrence, severity, and location.
目的：本研究旨在开发一种基于患者特定 3 维（3D）打印组织模拟模型的经导管主动脉瓣置换术（TAVR）手术模拟平台。我们研究了使用这些 3D 打印模型来定量预测任何程度 TAVR 瓣周漏（PVL）发生、严重程度和位置的可行性。
背景：我们之前已经证明，超材料 3D 打印技术可用于创建模拟生物组织力学性能的患者特定模型。这可能在心血管介入治疗的手术规划中有应用。
方法：这项回顾性研究纳入了 18 名接受 TAVR 的患者。使用组织模拟 3D 打印技术，根据术前 TAVR 计算机断层扫描，创建患者特定的主动脉根部模型。在模型中部署 CoreValve（自膨式瓣膜）假体以模拟 TAVR 手术，从体外量化 TAVR 后的主动脉根部应变。测量了一种新的指标，即瓣环膨出指数，以评估模型中 TAVR 后的瓣环应变不均匀性。我们测试了膨出指数和其他已知的 TAVR PVL 预测因子的比较预测价值。
结果：在无 PVL、微量至轻度 PVL 和中度至重度 PVL 的患者亚组之间，最大瓣环膨出指数有显著差异（p = 0.001）。与其他已知的 PVL 预测因子相比，膨出指数是唯一能显著预测中重度 PVL 的因子（曲线下面积 95%；p < 0.0001）。此外，在 12 名 TAVR 后有 PVL 的患者中，9 名患者的瓣环膨出指数预测了主要的 PVL 位置（准确性 75%）。
结论：在这项概念验证研究中，我们已经证明了使用 3D 打印组织模拟模型在体外定量评估 TAVR 后主动脉根部应变的可行性。瓣环膨出指数是一种新的瓣环应变不均匀的指标，在预测 TAVR 后 PVL 的发生、严重程度和位置方面，其表现优于其他已建立的变量，且具有较高的准确性。
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