IBiTech-bioMMeda, Ghent University, Ghent, Belgium.
Department of Cardiology, Erasmus MC, Rotterdam, The Netherlands.
J Cardiovasc Transl Res. 2019 Oct;12(5):435-446. doi: 10.1007/s12265-019-09877-2. Epub 2019 Aug 23.
Transcatheter aortic valve implantation has become an established procedure to treat severe aortic stenosis. Correct device sizing/positioning is crucial for optimal outcome. Lotus valve sizing is based upon multiple aortic root dimensions. Hence, it often occurs that two valve sizes can be selected. In this study, patient-specific computer simulation is adopted to evaluate the influence of Lotus size/position on paravalvular aortic regurgitation (AR) and conduction abnormalities, in patients with equivocal aortic root dimensions. First, simulation was performed in 62 patients to validate the model in terms of predicted AR and conduction abnormalities using postoperative echocardiographic, angiographic and ECG-based data. Then, two Lotus sizes were simulated at two positions in patients with equivocal aortic root dimensions. Large valve size and deep position were associated with higher contact pressure, while only large size, not position, significantly reduced the predicted AR. Despite general trends, simulations revealed that optimal device size/position is patient-specific.
经导管主动脉瓣植入术已成为治疗严重主动脉瓣狭窄的一种既定方法。正确的器械尺寸/定位对于获得最佳结果至关重要。莲花瓣膜尺寸基于多个主动脉根部尺寸。因此，通常可以选择两种瓣膜尺寸。在这项研究中，采用患者特异性计算机模拟来评估在主动脉根部尺寸不确定的患者中，莲花瓣膜尺寸/位置对瓣周主动脉瓣反流（AR）和传导异常的影响。首先，在 62 名患者中进行了模拟，使用术后超声心动图、血管造影和基于 ECG 的数据来验证模型预测 AR 和传导异常的准确性。然后，在主动脉根部尺寸不确定的患者中模拟了两种莲花瓣膜尺寸和两种位置。大瓣膜尺寸和深位置与较高的接触压力相关，而只有大尺寸而不是位置显著降低了预测的 AR。尽管存在一般趋势，但模拟结果表明，最佳器械尺寸/位置是因人而异的。
