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Chrysostomidis G, Apostolos A, Papanikolaou A, Konstantinou K, Tsigkas G, Koliopoulou A, Chamogeorgakis T. The Application of Precision Medicine in Structural Heart Diseases: A Step towards the Future. J Pers Med 2024; 14:375. [PMID: 38673001 PMCID: PMC11051532 DOI: 10.3390/jpm14040375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Revised: 03/20/2024] [Accepted: 03/23/2024] [Indexed: 04/28/2024] Open
Abstract
The personalized applications of 3D printing in interventional cardiology and cardiac surgery represent a transformative paradigm in the management of structural heart diseases. This review underscores the pivotal role of 3D printing in enhancing procedural precision, from preoperative planning to procedural simulation, particularly in valvular heart diseases, such as aortic stenosis and mitral regurgitation. The ability to create patient-specific models contributes significantly to predicting and preventing complications like paravalvular leakage, ensuring optimal device selection, and improving outcomes. Additionally, 3D printing extends its impact beyond valvular diseases to tricuspid regurgitation and non-valvular structural heart conditions. The comprehensive synthesis of the existing literature presented here emphasizes the promising trajectory of individualized approaches facilitated by 3D printing, promising a future where tailored interventions based on precise anatomical considerations become standard practice in cardiovascular care.
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Affiliation(s)
- Grigorios Chrysostomidis
- Second Department of Adult Cardiac Surgery—Heart and Lung Transplantation, Onassis Cardiac Surgery Center, 176 74 Athens, Greece; (G.C.); (A.K.); (T.C.)
| | - Anastasios Apostolos
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece;
| | - Amalia Papanikolaou
- First Department of Cardiology, National and Kapodistrian University of Athens, Hippocration General Hospital, 115 27 Athens, Greece;
| | - Konstantinos Konstantinou
- Royal Brompton and Harefield Hospitals, Guy’s and St Thomas’ NHS Foundation Trust, London 26504, UK;
| | - Grigorios Tsigkas
- Department of Cardiology, University Hospital of Patras, 265 04 Patras, Greece;
| | - Antigoni Koliopoulou
- Second Department of Adult Cardiac Surgery—Heart and Lung Transplantation, Onassis Cardiac Surgery Center, 176 74 Athens, Greece; (G.C.); (A.K.); (T.C.)
| | - Themistokles Chamogeorgakis
- Second Department of Adult Cardiac Surgery—Heart and Lung Transplantation, Onassis Cardiac Surgery Center, 176 74 Athens, Greece; (G.C.); (A.K.); (T.C.)
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Zhu Z, Xiong T, Chen M. Comparison of patients with bicuspid and tricuspid aortic valve in transcatheter aortic valve implantation. Expert Rev Med Devices 2023; 20:209-220. [PMID: 36815427 DOI: 10.1080/17434440.2023.2184686] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/24/2023]
Abstract
BACKGROUND Transcatheter aortic valve implantation (TAVI) has emerged as a safe and effective alternative to surgery for aortic stenosis (AS). However, there are still differences in the procedural process and outcome of bicuspid aortic valve (BAV) treated with TAVI compared with tricuspid aortic valve. AREAS COVERED This review paper aims to summarize the main characteristics and clinical evidence of TAVI in patients with bicuspid and tricuspid aortic valves and compare the outcomes of TAVI procedure. EXPERT OPINION The use of TAVI in patients with BAV has shown similar clinical outcomes compared with tricuspid aortic valve. The efficacy of TAVI for challenging BAV anatomies remains a concern due to the lack of randomized trials. Detailed preprocedural planning is of great importance in low-surgical-risk BAV patients. A better understanding of which subtypes of BAV anatomy are at greater risk for adverse outcomes can potentially benefit the selection of TAVI or open-heart surgery in low surgical risk AS patients.
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Affiliation(s)
- Zhongkai Zhu
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Tianyuan Xiong
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
| | - Mao Chen
- Department of Cardiology, West China Hospital, Sichuan University, Chengdu, China
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Ma Y, Mao Y, Zhu G, Yang J. Application of cardiovascular 3-dimensional printing in Transcatheter aortic valve replacement. CELL REGENERATION (LONDON, ENGLAND) 2022; 11:35. [PMID: 36121512 PMCID: PMC9485371 DOI: 10.1186/s13619-022-00129-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/25/2022] [Accepted: 07/05/2022] [Indexed: 11/10/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has been performed for nearly 20 years, with reliable safety and efficacy in moderate- to high-risk patients with aortic stenosis or regurgitation, with the advantage of less trauma and better prognosis than traditional open surgery. However, because surgeons have not been able to obtain a full view of the aortic root, 3-dimensional printing has been used to reconstruct the aortic root so that they could clearly and intuitively understand the specific anatomical structure. In addition, the 3D printed model has been used for the in vitro simulation of the planned procedures to predict the potential complications of TAVR, the goal being to provide guidance to reasonably plan the procedure to achieve the best outcome. Postprocedural 3D printing can be used to understand the depth, shape, and distribution of the stent. Cardiovascular 3D printing has achieved remarkable results in TAVR and has a great potential.
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Affiliation(s)
- Yanyan Ma
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Yu Mao
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, 710032, Shaanxi, China
| | - Guangyu Zhu
- School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an, China
| | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Air Force Medical University, 127 Changle West Road, Xi'an, 710032, Shaanxi, China.
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Xenofontos P, Zamani R, Akrami M. The application of 3D printing in preoperative planning for transcatheter aortic valve replacement: a systematic review. Biomed Eng Online 2022; 21:59. [PMID: 36050722 PMCID: PMC9434927 DOI: 10.1186/s12938-022-01029-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 08/24/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Recently, transcatheter aortic valve replacement (TAVR) has been suggested as a less invasive treatment compared to surgical aortic valve replacement, for patients with severe aortic stenosis. Despite the attention, persisting evidence suggests that several procedural complications are more prevalent with the transcatheter approach. Consequently, a systematic review was undertaken to evaluate the application of three-dimensional (3D) printing in preoperative planning for TAVR, as a means of predicting and subsequently, reducing the incidence of adverse events. METHODS MEDLINE, Web of Science and Embase were searched to identify studies that utilised patient-specific 3D printed models to predict or mitigate the risk of procedural complications. RESULTS 13 of 219 papers met the inclusion criteria of this review. The eligible studies have shown that 3D printing has most commonly been used to predict the occurrence and severity of paravalvular regurgitation, with relatively high accuracy. Studies have also explored the usefulness of 3D printed anatomical models in reducing the incidence of coronary artery obstruction, new-onset conduction disturbance and aortic annular rapture. CONCLUSION Patient-specific 3D models can be used in pre-procedural planning for challenging cases, to help deliver personalised treatment. However, the application of 3D printing is not recommended for routine clinical practice, due to practicality issues.
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Affiliation(s)
| | - Reza Zamani
- Medical School, College of Medicine and Health, Exeter, UK
| | - Mohammad Akrami
- Department of Engineering, College of Engineering, Mathematics, and Physical Sciences, University of Exeter, Exeter, UK.
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Prisco AR, Zhingre-Sanchez J, Mattison L, Yannopoulos D, Raveendran G, Iaizzo PA, Gurevich S. The native aortic valve reduces paravalvular leak in TAVR patients. Front Physiol 2022; 13:910016. [PMID: 35991166 PMCID: PMC9388752 DOI: 10.3389/fphys.2022.910016] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2022] [Accepted: 07/11/2022] [Indexed: 11/13/2022] Open
Abstract
Background: Paravalvular leak (PVL) is a frequent TAVR complication. Prospective identification of patients who are likely to develop PVL after TAVR would likely lead to improved outcomes. Prior studies have used geometric characteristics to predict the likelihood of PVL development, but prediction and quantification has not been done. One of the reasons is that it is difficult to predict the mechanical deformation of the native diseased aortic valve prior to implantation of the prosthetic valve, as existing calcifications likely contribute to the seal between the prosthetic valve and the aortic annulus. However, the relatively amount the native valve plays in preventing PVL is unknown. Methods: A retrospective chart review was conducted identifying patients with mild or greater PVL. One patient who had substantial PVL was identified and a 3D printed (pre-TAVR) aortic root was created. Balloon-expandable TAVR stent frames were implanted within the 3D printed root and a new model was created. Using this geometry, computational fluid dynamics (CFD) simulations were done to quantify PVL. The PVL flow path was iteratively decreased to simulate the space occupied by a crushed native aortic valve and PVL was quantified. Results: PVL was found to decrease as the space occupying the PVL area increased, demonstrating that the native aortic valve contributes to reducing regurgitation. CFD simulations demonstrated that within the patient analyzed, the native valve occupies between 3–40% of the PVL pathway. Conclusion:A priori techniques that predict the development of post TAVR PVL should account for the native diseased valve as our simulations demonstrate that it plays a role in reducing PVL.
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Affiliation(s)
- Anthony R. Prisco
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, United States
- Department of Surgery, Visible Heart Laboratories, University of Minnesota, Minneapolis, MN, United States
| | - Jorge Zhingre-Sanchez
- Department of Surgery, Visible Heart Laboratories, University of Minnesota, Minneapolis, MN, United States
- Department of Biomedical Engineering, University of MN, Minneapolis, MN, United States
| | - Lars Mattison
- Department of Surgery, Visible Heart Laboratories, University of Minnesota, Minneapolis, MN, United States
- Department of Biomedical Engineering, University of MN, Minneapolis, MN, United States
| | - Demetris Yannopoulos
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, United States
| | - Ganesh Raveendran
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, United States
| | - Paul A. Iaizzo
- Department of Surgery, Visible Heart Laboratories, University of Minnesota, Minneapolis, MN, United States
| | - Sergey Gurevich
- Department of Medicine, Division of Cardiology, University of Minnesota, Minneapolis, MN, United States
- *Correspondence: Sergey Gurevich,
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Bernhard B, Illi J, Gloeckler M, Pilgrim T, Praz F, Windecker S, Haeberlin A, Gräni C. Imaging-Based, Patient-Specific Three-Dimensional Printing to Plan, Train, and Guide Cardiovascular Interventions: A Systematic Review and Meta-Analysis. Heart Lung Circ 2022; 31:1203-1218. [PMID: 35680498 DOI: 10.1016/j.hlc.2022.04.052] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2021] [Accepted: 04/14/2022] [Indexed: 01/07/2023]
Abstract
BACKGROUND To tailor cardiovascular interventions, the use of three-dimensional (3D), patient-specific phantoms (3DPSP) encompasses patient education, training, simulation, procedure planning, and outcome-prediction. AIM This systematic review and meta-analysis aims to investigate the current and future perspective of 3D printing for cardiovascular interventions. METHODS We systematically screened articles on Medline and EMBASE reporting the prospective use of 3DPSP in cardiovascular interventions by using combined search terms. Studies that compared intervention time depending on 3DPSP utilisation were included into a meta-analysis. RESULTS We identified 107 studies that prospectively investigated a total of 814 3DPSP in cardiovascular interventions. Most common settings were congenital heart disease (CHD) (38 articles, 6 comparative studies), left atrial appendage (LAA) occlusion (11 articles, 5 comparative, 1 randomised controlled trial [RCT]), and aortic disease (10 articles). All authors described 3DPSP as helpful in assessing complex anatomic conditions, whereas poor tissue mimicry and the non-consideration of physiological properties were cited as limitations. Compared to controls, meta-analysis of six studies showed a significant reduction of intervention time in LAA occlusion (n=3 studies), and surgery due to CHD (n=3) if 3DPSPs were used (Cohen's d=0.54; 95% confidence interval, 0.13 to 0.95; p=0.001), however heterogeneity across studies should be taken into account. CONCLUSIONS 3DPSP are helpful to plan, train, and guide interventions in patients with complex cardiovascular anatomy. Benefits for patients include reduced intervention time with the potential for lower radiation exposure and shorter mechanical ventilation times. More evidence and RCTs including clinical endpoints are needed to warrant adoption of 3DPSP into routine clinical practice.
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Affiliation(s)
- Benedikt Bernhard
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Joël Illi
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Swiss MedTech Center, Switzerland Innovation Park Biel/Bienne AG, Switzerland
| | - Martin Gloeckler
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Thomas Pilgrim
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Fabien Praz
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Stephan Windecker
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland
| | - Andreas Haeberlin
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, Sitem Center, University of Bern, Switzerland
| | - Christoph Gräni
- Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland; Translational Imaging Center, Sitem Center, University of Bern, Switzerland.
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Mao Y, Liu Y, Ma Y, Jin P, Li L, Yang J. Mitral Valve-in-Valve Implant of a Balloon-Expandable Valve Guided by 3-Dimensional Printing. Front Cardiovasc Med 2022; 9:894160. [PMID: 35711355 PMCID: PMC9195497 DOI: 10.3389/fcvm.2022.894160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Accepted: 05/03/2022] [Indexed: 11/27/2022] Open
Abstract
Background Our goal was to explore the role of 3-dimensional (3D) printing in facilitating the outcome of a mitral valve-in-valve (V-in-V) implant of a balloon-expandable valve. Methods From November 2020 to April 2021, 6 patients with degenerated mitral valves were treated by a transcatheter mitral V-in-V implant of a balloon-expandable valve. 3D printed mitral valve pre- and post-procedure models were prepared to facilitate the process by making individualized plans and evaluating the outcomes. Results Each of the 6 patients was successfully implanted with a balloon-expandable valve. From post-procedural images and the 3D printed models, we could clearly observe the valve at the ideal position, with the proper shape and no regurgitation. 3D printed mitral valve models contributed to precise decisions, the avoidance of complications, and the valuation of outcomes. Conclusions 3D printing plays an important role in guiding the transcatheter mitral V-in-V implant of a balloon-expandable valve. Clinical Trial Registration ClinicalTrials.gov Protocol Registration System (NCT02917980).
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Affiliation(s)
| | | | | | | | | | - Jian Yang
- Department of Cardiovascular Surgery, Xijing Hospital, Fourth Military Medical University, Xi'an, China
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Treatment of Bicuspid Aortic Valve Stenosis with TAVR: Filling Knowledge Gaps Towards Reducing Complications. Curr Cardiol Rep 2022; 24:33-41. [PMID: 35099762 DOI: 10.1007/s11886-021-01617-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/24/2021] [Indexed: 12/22/2022]
Abstract
PURPOSE OF REVIEW Bicuspid aortic valve (BAV) disease is the most common congenital heart defect worldwide. When severe, symptomatic aortic stenosis ensues, the treatment has increasingly become transcatheter aortic valve replacement (TAVR). The purpose of this review is to identify BAV classification and imaging methods, outline TAVR outcomes in BAV anatomy, and discuss how computational modeling can enhance TAVR treatment in BAV patients. RECENT FINDINGS TAVR use in BAV patients, when compared to use in tricuspid aortic valves, showed lower device success rate, and there remains no long-term randomized trial data. It has been reported that BAV patients with severe calcification increase the rate of complications. Additionally, the asymmetrical morphology of BAVs often results in asymmetric stent geometries which have implications for increased thrombosis risk and decreased durability. These adverse outcomes are currently very difficult to predict from routine pre-procedural imaging alone. Recently developed patient specific experimental and computational techniques have the potential to assist in filling knowledge gaps in the mechanisms of these complications and provide more information during preclinical planning for better TAVR selection in low surgical risk BAV patients. Efficacy of TAVR for irregular BAV anatomies remains concerning due to the lack of a long-term randomized trial data, their increased rate of short-term complications, and signs that long-term durability could be an issue. More knowledge on identifying which BAV anatomies are at greater risk for these adverse outcomes can potentially improve patient selection for TAVR versus SAVR in low surgical risk BAV patients.
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Yamamoto T, Endo D, Yamaoka H, Matsushita S, Kajimoto K, Asai T, Amano A. A new technique that prevents paravalvular leakage after aortic valve replacement using a rapid-deployment valve system. J Card Surg 2021; 36:2225-2232. [PMID: 33783050 DOI: 10.1111/jocs.15513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2021] [Accepted: 01/31/2021] [Indexed: 12/01/2022]
Abstract
BACKGROUND We report our 1-year single-center experience of a new technique of aortic valve replacement using a rapid-deployment valve (RD-AVR) to avoid postoperative complications. We also report the unexpected pitfalls and handling techniques that we have seen in past cases. METHODS We performed aortic valve replacement on 38 patients between May 2019 and April 2020. Their mean age was 74 years. The primary outcomes were in-hospital mortality and short-term results during a 1-year follow-up period, while the secondary outcomes were related to prosthetic valve function, especially paravalvular leakage (PVL). We further analyzed the relationship between the new technique and its outcomes. RESULTS The mean operative time was 196 min. There were no in-hospital deaths, and the mean duration of postoperative hospital stay was 11.8 days. Valvular measurements using three-dimensional computed tomography were larger and more accurate than those measured using ultrasonic echocardiography. Postoperative RD-AVR prosthetic valve function was excellent. However, PVL occurred in four cases 1 week and 1 year postoperatively and regurgitation did not improve. A gap associated with PVL was identified below the right-noncoronary commissure. To prevent PVL, we additionally stitched this gap in the later 18 cases; there was no case of PVL and no new pacemaker implantation in these cases. CONCLUSIONS PVL is more likely to occur if there is a gap below the R-N commissure, especially in cases with a large annulus; therefore, applying an additional stitch to the R-N commissure is extremely useful.
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Affiliation(s)
- Taira Yamamoto
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Daisuke Endo
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Hironobu Yamaoka
- Department of Cardiovascular Surgery, Edogawa Hospital, Tokyo, Japan
| | | | - Kan Kajimoto
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Tohru Asai
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
| | - Atsushi Amano
- Department of Cardiovascular Surgery, Juntendo University, Tokyo, Japan
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Abd Alamir M, Nazir S, Alani A, Golub I, Gilchrist IC, Aslam F, Dhawan P, Changal K, Ostra C, Soni R, Elzanaty A, Budoff M. Multidetector computed tomography in transcatheter aortic valve replacement: an update on technological developments and clinical applications. Expert Rev Cardiovasc Ther 2020; 18:709-722. [PMID: 33063552 DOI: 10.1080/14779072.2020.1837624] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has revolutionized the treatment of patients with underlying sever aortic valve stenosis across all spectrum of the disease. CT imaging is so crucial to the pre procedural planning, to incorporate the information from the CT imaging in the decision making intraprocedurally and to predict and identity the post procedural complications.Areas covered: In this article, we review available studies on CT role in TAVR procedure and provide update on the technological developments and clinical applications.Expert opinion: CT imaging, with its high resolution, and in particular its utilization in aortic annular measurements, bicuspid aortic valve assessment, hypoattenuated leaflet thickening and valve in valve therapy proved to be the ideal approach to study the mechanisms of aortic stenosis, detection of high-risk anatomy, more accurate risk stratification and thus to allow a personalized catheter based intervention of the affected patients.
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Affiliation(s)
- Moshrik Abd Alamir
- Department of Cardiology, Stony Brook University Hospital, Health Sciences Tower , Stony Brook, NY, USA
| | - Salik Nazir
- Department of Cardiology, University of Toledo , Toledo, OH, USA
| | - Anas Alani
- Loma Linda University , Loma Linda, CA, USA
| | - Ilana Golub
- Department of Cardiology, Lundquist Institute , Torrance, CA, USA
| | - Ian C Gilchrist
- Department of Cardiology, Stony Brook University Hospital, Health Sciences Tower , Stony Brook, NY, USA
| | - Faisal Aslam
- Department of Cardiology, Stony Brook University Hospital, Health Sciences Tower , Stony Brook, NY, USA
| | - Puneet Dhawan
- David Geffen School of Medicine at UCLA, Department of Surgery, Los Angeles County Harbor-UCLA Medical Center , Torrance, CA, USA
| | - Khalid Changal
- Department of Cardiology, University of Toledo , Toledo, OH, USA
| | - Carson Ostra
- Department of Cardiology, University of Toledo , Toledo, OH, USA
| | - Ronak Soni
- Department of Cardiology, University of Toledo , Toledo, OH, USA
| | - Ahmad Elzanaty
- Department of Cardiology, University of Toledo , Toledo, OH, USA
| | - Matthew Budoff
- Department of Cardiology, Lundquist Institute , Torrance, CA, USA
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