Patient-specific computer simulation to predict long-term outcomes after transcatheter aortic valve replacement

Area of Science:

• Cardiovascular Engineering
• Medical Imaging
• Computational Fluid Dynamics

Background:

• Transcatheter aortic valve replacement (TAVR) is a common procedure for severe aortic stenosis.
• Paravalvular regurgitation (PVR) is a potential complication after TAVR.
• Predicting PVR and its long-term consequences remains a clinical challenge.

Purpose of the Study:

• To investigate the utility of patient-specific computer simulations in predicting PVR after TAVR.
• To determine if simulated PVR can identify patients at risk for long-term adverse outcomes.

Main Methods:

• A multi-center retrospective study involving 203 patients undergoing TAVR with self-expanding valves.
• Finite element analysis (FEA) of patient-specific aortic root models derived from CT imaging.
• Computational fluid dynamics (CFD) simulations to predict PVR, categorizing patients into significant (≥16.0 mL/s) and non-significant (<16.0 mL/s) predicted PVR groups.

Main Results:

• Higher rates of all-cause mortality at 2 years were observed in patients with predicted significant PVR (35.8%) compared to those with predicted non-significant PVR (16.3%).
• The hazard ratio for death in the significant PVR group was 2.62 (95% CI, 1.29-5.30; P=0.006).
• Specific valve types included CoreValve, Evolut R, and Evolut PRO.

Conclusions:

• Patient-specific computer simulation, utilizing FEA and CFD, can predict PVR after TAVR.
• This simulation approach may serve as a valuable tool for identifying TAVR patients at increased risk of long-term mortality.