Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, CA, USA; MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
MonashHeart, Monash Health and Monash Cardiovascular Research Centre, Monash University, Melbourne, Australia.
Cardiovasc Revasc Med. 2023 Jun;51:31-37. doi: 10.1016/j.carrev.2023.01.015. Epub 2023 Jan 24.
Transcatheter aortic valve replacement (TAVR) is increasingly being used to treat younger, lower-risk patients with bicuspid aortic valve (BAV). Patient-specific computer simulation may identify patients at risk for developing paravalvular regurgitation (PVR) and major conduction disturbance. Only limited prospective experience of this technology exist. We wished to describe our ongoing experience with patient-specific computer simulation.
Patients who were referred for consideration of TAVR with a self-expanding transcatheter heart valve (THV) and had BAV identified on pre-procedural cardiac computed tomography imaging underwent patient-specific computer simulation. The computer simulations were reviewed by the Heart Team and used to guide surgical or transcatheter treatment approaches and to aid in THV sizing and positioning. Clinical outcomes were recorded.
Between May 2019 and May 2021, 16 patients with BAV were referred for consideration of TAVR with a self-expanding THV. Sievers Type 1 morphology was present in 15 patients and Type 0 in the remaining patient. Two patients were predicted to develop moderate-to-severe PVR with a TAVR procedure and these patients underwent successful surgical aortic valve replacement. In the remaining 14 patients, computer simulation was used to optimize THV sizing and positioning to minimise PVR and conduction disturbance. One patient with a low valve implantation depth developed moderate PVR and this complication was correctly predicted by the computer simulations. No patient required insertion of a new permanent pacemaker.
Patient-specific computer simulation may be used to guide the most appropriate treatment modality for patients with BAV. The usage of computer simulation to guide THV sizing and positioning was associated with favourable clinical outcomes.
经导管主动脉瓣置换术（TAVR）越来越多地用于治疗具有二叶式主动脉瓣（BAV）的年轻、低危患者。患者特异性计算机模拟可识别发生瓣周漏（PVR）和主要传导障碍风险的患者。目前仅有限的前瞻性经验存在。我们希望描述我们正在进行的患者特异性计算机模拟经验。
对接受经导管心脏瓣膜（THV）自膨式 TAVR 治疗并在术前心脏计算机断层扫描成像中发现 BAV 的患者进行患者特异性计算机模拟。心脏团队对计算机模拟进行了审查，并将其用于指导手术或经导管治疗方法，以及帮助 THV 尺寸和定位。记录临床结果。
在 2019 年 5 月至 2021 年 5 月期间，16 例 BAV 患者因考虑接受自膨式 THV 的 TAVR 治疗而被转诊。15 例患者存在 Sievers 1 型形态，其余 1 例患者存在 0 型形态。两名患者预计在 TAVR 手术后会发生中度至重度 PVR，这两名患者成功接受了外科主动脉瓣置换术。在其余 14 例患者中，计算机模拟用于优化 THV 尺寸和定位，以最大限度地减少 PVR 和传导障碍。一名患者的瓣膜植入深度较低，发生中度 PVR，计算机模拟正确预测了这一并发症。没有患者需要插入新的永久性起搏器。
患者特异性计算机模拟可用于指导 BAV 患者最合适的治疗方式。使用计算机模拟来指导 THV 尺寸和定位与良好的临床结果相关。
