Modeling of valve-in-valve transcatheter aortic valve implantation after aortic root replacement using a...

Area of Science:

• Cardiovascular Surgery
• Interventional Cardiology
• Biomedical Engineering

Background:

• Aortic root replacement involves complex reconstruction, necessitating coronary artery reimplantation.
• Valve-in-valve transcatheter aortic valve implantation (ViV TAVI) is an emerging option for degenerated bioprosthetic valves.

Purpose of the Study:

• To assess the feasibility and safety of ViV TAVI following aortic root replacement.
• To evaluate coronary obstruction risk and potential stent deformation using computational modeling.

Main Methods:

• Retrospective review of 74 patients undergoing aortic root replacement with composite valve-grafts.
• Analysis of 40 patients with bioprosthetic valves using gated computed tomographic angiography.
• Computational simulations of balloon- and self-expanding TAVI deployments.

Main Results:

• Modeled valve-to-coronary distances differed significantly from manual measurements (P < .05).
• 3D modeling indicated low risk of coronary obstruction for most patients, even with distances <4 mm.
• One patient (balloon valve) was at risk for left coronary obstruction; 5 patients (12.5%) showed risk of stent deformation.

Conclusions:

• All patients were suitable candidates for ViV TAVI after aortic root replacement.
• Self-expanding valves carry a higher risk of stent deformation at graft anastomoses.
• Balloon-expandable valves present a greater risk of coronary obstruction.