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Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Coronary obstruction analysis in transcatheter aortic valve implantation through patient-specific computational
Jiaqi Fan1,2, Jun Chen1, Lihan Wang1
1Department of Cardiology, Second Affiliated Hospital Zhejiang University School of Medicine, Hangzhou, China.
Insights
Patient-specific computer simulations can predict coronary obstruction (CO) risk during transcatheter aortic valve replacement (TAVR). Shorter distances between coronary ostia and adjacent structures indicate higher CO risk, aiding pre-procedural planning.
Area of Science:
- Cardiovascular Interventions
- Computational Modeling
- Medical Imaging
Background:
- Coronary obstruction (CO) is a rare but serious complication during transcatheter aortic valve replacement (TAVR).
- Accurate risk assessment for CO is crucial for patient safety during TAVR procedures.
Purpose of the Study:
- To evaluate the association between predicted coronary ostia-to-structure distance from patient-specific computer simulations and the risk of CO during TAVR.
- To determine if computational modeling can identify patients at risk for CO before TAVR.
Main Methods:
- Retrospective analysis of 14 patients undergoing TAVR with finite element simulation.
- Comparison of simulated and post-operative device deformation using a high coefficient of determination (≥0.95).
- Calculation of minimum distance between coronary ostia and closest structures in patients with and without CO risk.
Main Results:
- Simulations accurately predicted device deformation.
- Patients experiencing CO had significantly shorter distances between coronary ostia and adjacent structures compared to high-risk and no-risk groups (e.g., left coronary: 3.0mm vs. 3.3mm vs. 6.5mm).
Conclusions:
- Patient-specific computational simulation can predict CO risk by measuring coronary ostia proximity.
- This technology offers a potential tool for pre-TAVR risk stratification and prevention of coronary obstruction.
Background:
Coronary obstruction (CO) is a rare but devasting complication during transcatheter aortic valve replacement (TAVR).
Objectives:
We aim to demonstrate that the predicted distance between the coronary ostia and the closest structure derived with patient-specific computer simulation is associated with CO risk during TAVR.
Methods:
We retrospectively analysed 14 aortic stenosis patients who underwent TAVR through finite element simulation. The frame deformation predicted with patient-specific computer simulation was qualitatively and quantitatively compared to the post-operative device deformation. The minimum distance between each coronary ostium and the closest structure was calculated and compared in patients who developed CO, at high risk of CO, and at no risk of CO.
Results:
Four patients experienced CO during TAVR, 5 patients were at high risk of CO, and the remaining 5 patients had no risk of CO. A high coefficient of determination was obtained for all measurements extracted from the simulated device and the post-operative device (≥0.95). Simulations predicted shorter distance between the coronary ostium and the closest structure in patients who experienced CO, compared to patients at high risk of CO or who did not experience this complication (right coronary: 5.9 vs. 6.8 vs. 8.8 mm, left coronary: 3.0 vs. 3.3 vs. 6.5 mm respectively).
Conclusions:
The distance between the coronary ostium and the closest structure was lower in patients who experienced CO during TAVR through patient-specific computational simulation. This technology enables coronary obstruction analysis before TAVR in the future.
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