Morphology and calcification characterization in patients undergoing TAVI: A 3D statistical shape modelling study

Area of Science:

• Cardiovascular Medicine
• Medical Imaging
• Biomedical Engineering

Background:

• Aortic stenosis (AS) is a growing global health concern, particularly in aging populations.
• Transcatheter aortic valve implantation (TAVI) is a key intervention for AS, but complications like paravalvular leakage (PVL) persist.
• Previous studies on TAVI outcomes were limited by the availability and reproducibility of clinical measurements.

Purpose of the Study:

• To enhance the characterization of AS patients undergoing TAVI.
• To analyze clinical findings alongside advanced 3D morphological analysis of the aortic root, left ventricular outflow tract, and calcification patterns.
• To investigate the association between patient-specific morphology and TAVI procedural outcomes, including PVL.

Main Methods:

• Retrospective analysis of 130 AS patients who underwent TAVI.
• Collection of pre- and post-TAVI demographic and clinical data.
• 3D reconstruction and statistical shape modeling from pre-operative CT images to analyze aortic root and calcification morphology.
• Correlation of morphological findings with clinical outcomes, including PVL assessed by echocardiography.

Main Results:

• 3D valve calcification patterns were consistent with prior descriptions, showing crescent shapes and higher calcification in the non-coronary cusp.
• Higher calcification correlated with larger valves and coronary height.
• Significant sexual dimorphism in aortic shape and calcification was observed, with males having straighter aortas and higher calcification near coronary leaflets.
• Morphological differences, including aortic size and coronary sinus length, were significantly associated with PVL (p = 0.005).
• Female phenotypes with smaller, conic aortic roots were linked to worse outcomes.
• Larger aortas and shorter left coronary sinuses were associated with reduced PVL.

Conclusions:

• Advanced 3D morphological analysis provides deeper insights into AS patient anatomy relevant to TAVI.
• Patient-specific aortic root and valve calcification characteristics significantly influence TAVI outcomes, particularly PVL.
• Understanding these morphological factors, including sexual dimorphism, can help predict post-TAVI PVL and guide the development of improved TAVI devices.
• Personalized TAVI strategies based on detailed anatomical assessment may improve procedural success and reduce complications.