Computer generated heart valve model [Image from Sergey Gurevich]
One of the common risks associated with TAVR is valves not fitting which can cause PVL. A recent study conducted by cardiovascular fellow Dr. Sergey Gurevich used 3D printing technology to confirm and locate where the leak occurred.
Approximately 25,000 people die every year from under-recognized heart valve disease, according to the American Heart Association. Age, a history of rheumatic fever or infective endocarditis, heart attack, heart failure or previous heart valve conditions from birth increase the risk for developing heart valve disease. More than five million Americans are diagnosed each year with the disease.
The TAVR procedure is used for intermediate, high-risk and inoperable patients who have a server narrowing of the aortic valve where a prosthetic valve was implanted. The damaged valve is replaced in the less invasive procedure, but complications like a paravalvular leak around the new valve can lead to higher mortality rates. Because of these complications, clinicians are looking for ways to find and prevent the leaks.
Six patients who were undergoing TAVR for severe, calcific aortic stenosis participated in the study. They all were at-risk for PVL and had computed tomography images taken and analyzed before the procedure. The images were segmented for the printing of 3D models. CT scans allowed the researchers to view the location of the calcium build up in a 360-degree view to evaluate the poorly fitted valves. 3D aortic root models were implants with the valve to see if it was the correct size while simultaneously seeing where the calcium composites are located.
The 3D models are scanned and evaluated fro a final analysis and compared to in vivo implanted TAVR echocardiograms. All of the leaks that are seen on the 3D models were confirmed on CT digital scans as well. The models allowed researchers to use prototypes to personalize valve placement, size and location to alleviate leaks and reduce calcium build up, according to the researchers.
“We are very encouraged to see such positive outcomes for the feasibility of 3D printing in patients with heart valve disease. These patients are at a high risk of developing a leak after TAVR, and anything we can do to identify and prevent these leaks from happening is certainly helpful,” Gurevich, who was the lead author on the study, said in a press release.
The researchers hope to create a functional study to determine the exact size of leaks in the future and they are continuing to work with computational fluid dynamics to optimize their calculations.
