Before now, there has not been any effective method to predict paravalvular regurgitation prior to transcatheter aortic valve replacement (TAVR). However, new research has developed a new method for preprocedural modelling using 3D printing and ex vivo implantation to successfully predict the incidence of paravalvular leak and the site of leak after transcatheter aortic valve replacement.
According to the research published in NCBI, the researchers analyzed pre-TAVR computed tomography (CT) scans of 20 patients (n = 20; median age, 78 years; 70% men) who underwent TAVR for severe, calcific aortic stenosis and then made a 3D printed version of the aortic root of each patient. Models were printed using Ninjaflex thermoplastic polyurethane.
These patients received the implants with Sapien balloon-expandable frames to match the implants in each patient. To confirm a leak, the researchers then evaluated and compared post-TAVR echograms with scans from a flash dual-source CT (Siemens) for relative stent appositions.
Out of 10 patients with echocardiographic paravalvular leaks, the analysis correctly showed the site of the leak for 8 patients.
“In our retrospective analyses of patients undergoing TAVR with and without postprocedure paravalvular leak, we found that 3D printing and ex vivo implantation of balloon-expandable transcatheter aortic valves can be employed to predict the presence of postprocedure paravalvular leak with high sensitivity (80%) and specificity (90%),” Christopher Reiff, MD, assistant professor in the department of family medicine and community health and director of clinical services at the Community-University Health Care Center at University of Minnesota Fairview Medical Center, and colleagues wrote. “To date, there has been no reported adequate predictor of paravalvular leak for patients undergoing TAVR. Yet, certain risk factors have been identified as associated with paravalvular leak.”