3D-Printing to Plan Complex Transcatheter Paravalvular Leaks Closure.

Area of Science:

• Cardiovascular Interventions
• Medical Device Technology
• 3D Printing Applications

Background:

• Percutaneous closure of paravalvular leak (PVL) is an alternative to surgery but faces challenges in achieving complete occlusion and preserving prosthesis function.
• Multimodal imaging is crucial for PVL morphology assessment to guide device selection.
• Predicting device-related adverse events like leaflet blockade or embolization is critical for patient safety.

Purpose of the Study:

• To evaluate the added value of 3D printing in predicting adverse events during transcatheter paravalvular leak closure.
• To explore the utility of 3D printed models in planning complex PVL closure procedures.
• To assess the accuracy of 3D printed models in guiding device selection and preventing complications.

Main Methods:

• Eleven transcatheter PVL closure procedures were analyzed from three centers using 3D printed models.
• Cardiac CT data was used for segmentation to create 3D printed models with thermoplastic polyurethane.
• Laser sintering technology (SLS) was employed, and device simulations were performed on the 3D printed models.

Main Results:

• PVLs were located around aortic, mitral prostheses, and tricuspid rings.
• Device selection based on 3D model simulation matched implanted devices in 8 out of 11 cases.
• Risk of leaflet blockade was identified in 4 cases, leading to adjustments and, in two cases, post-operative surgical intervention.

Conclusions:

• Hands-on simulation using 3D printed models is beneficial for planning complex transcatheter PVL closure.
• 3D printing aids in identifying potential complications, such as leaflet blockade, before device implantation.
• This technology enhances the safety and efficacy of challenging percutaneous PVL closure procedures.