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Updated: Jan 19, 2026
Four-Dimensional Computed Tomography-Guided Valve Sizing for Transcatheter Pulmonary Valve Replacement
Published on: January 20, 2022
Differences in clinical valve size selection and valve size selection for patient-specific computer simulation in
Nahid El Faquir1, Giorgia Rocatello2, Zouhair Rahhab1
1Department of Cardiology, Thoraxcenter, Erasmus Medical Center, 's-Gravendijkwal 230, 3015 CE, Rotterdam, The Netherlands.
Insights
Transcatheter aortic valve replacement (TAVR) valve sizing differs between clinical CT scans and computer simulations. Patient-specific simulations reveal complexities in TAVR valve selection beyond current practices.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
- Medical Imaging
Background:
- Current transcatheter aortic valve replacement (TAVR) valve size selection relies on cardiac CT scans.
- CT-based sizing does not assess crucial valve-host interactions.
- Patient-specific computer simulations offer an alternative approach to evaluate these interactions.
Purpose of the Study:
- To compare physician-led clinical valve size selection with expert-driven valve size selection using patient-specific computer simulations.
- To investigate discrepancies in TAVR valve sizing between standard clinical practice and simulation-based methods.
Main Methods:
- A multicenter retrospective analysis involving 141 patients undergoing TAVR with CoreValve or Evolut R devices.
- Baseline CT scans were utilized for both clinical sizing and patient-specific computer simulations.
- Valve size selection by the treating physician was compared against an independent expert's simulation-based recommendations.
Main Results:
- Overall concordance between clinical and simulated valve size selection was low (33%), with significant ambiguity (56%) and discordance (11%).
- In single-valve simulation scenarios (Cohort A), concordance was higher (76%), but discrepancies still occurred.
- In dual-valve simulation scenarios (Cohort B), all patients showed a different simulated valve size compared to the clinically selected one, with shifts towards smaller (57%) or larger (43%) sizes.
Conclusions:
- TAVR valve size selection is more complex than currently assumed, with notable differences between clinical practice and simulation-based expert evaluation.
- Patient-specific computer simulations highlight potential limitations of CT-based sizing and suggest a need for refined TAVR sizing strategies.
- These findings underscore the intricate nature of valve-host interactions in TAVR and the potential role of advanced simulation techniques.
Abstract:
Valve size selection for transcatheter aortic valve replacement (TAVR) is currently based on cardiac CT-scan. At variance with patient-specific computer simulation, this does not allow the assessment of the valve-host interaction. We aimed to compare clinical valve size selection and valve size selection by an independent expert for computer simulation. A multicenter retrospective analysis of valve size selection by the physician and the independent expert in 141 patients who underwent TAVR with the self-expanding CoreValve or Evolut R. Baseline CT-scan was used for clinical valve size selection and for patient-specific computer simulation. Simulation results were not available for clinical use. Overall true concordance between clinical and simulated valve size selection was observed in 47 patients (33%), true discordance in 15 (11%) and ambiguity in 79 (56%). In 62 (44%, cohort A) one valve size was simulated whereas two valve sizes were simulated in 79 (56%, cohort B). In cohort A, concordance was 76% and discordance was 24%; a smaller valve size was selected for simulation in 10 patients and a larger in 5. In cohort B, a different valve size was selected for simulation in all patients in addition to the valve size that was used for TAVR. The different valve size concerned a smaller valve in 45 patients (57%) and a larger in 34 (43%). Selection of the valve size differs between the physician and the independent computer simulation expert who used the same source of information. These findings indicate that valve sizing in TAVR is still more intricate than generally assumed.
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