The Accuracy of Patient-Specific Computer Modelling in Predicting Device Size and Paravalvular Aortic Regurgitation in Complex Transcatheter Aortic Valve Replacement Procedures

Background: Transcatheter aortic valve replacement (TAVR) is an accepted treatment in patients with severe aortic stenosis. Dedicated and validated computer simulation modeling offers additional information, accurately predicting patient and device-specific calcium displacement, presence, and severity of paravalvular aortic regurgitation (AR) and conduction disturbances post TAVR. We retrospectively assessed whether patient-specific computer modeling accurately predicted the device size and paravalvularAR in certain complex TAVR procedures. Methods: This single-center case series investigated retrospectively the accuracy of patient-specific computer modeling of six complex TAVR procedures with the self-expandable Evolut R (Medtronic, Minneapolis, USA) or mechanical expanded Lotus (Boston Scientific, Marlborough, USA). A dedicated patient-specific computer simulation was performed in each case and simulated the best fitting valve and predicted the presence and severity of paravalvular AR at different implantation depths. These simulation results were compared with procedural outcomes using transoesophageal echocardiography and aortography. Results: The dedicated patient-specific computer model accurately predicted valve size and paravalvular AR (severity and location). In two cases, there was a significant paravalvular AR post-implantation with Evolut R 34 mm, which was correctly predicted by the model, suggesting that these cases were not suitable for TAVR. In four cases, we have switched to a larger valve during the procedure. The computer model, indeed, showed better results with these large valves. Conclusion: Personalized computer models can accurately predict valve size and paravalvular AR in complex cases and may, therefore, offer additional support during decision-making, possibly preventing ad-hoc intra-procedural change of device. Before clinical implementation, prospective validation is necessary in a lager study population.