Megan Heitkemper1, Hoda Hatoum1, Amirsepehr Azimian1, Breandan Yeats1, Jennifer Dollery2, Bryan Whitson2, Greg Rushing2, Juan Crestanello3, Scott M Lilly4, Lakshmi Prasad Dasi5. 1. Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio. 2. Department of Surgery The Ohio State University, Columbus, Ohio. 3. Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio; Department of Surgery The Ohio State University, Columbus, Ohio. 4. Division of Cardiology, The Ohio State University, Columbus, Ohio. 5. Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio; Department of Surgery The Ohio State University, Columbus, Ohio. Electronic address: lakshmi.dasi@osumc.edu.
Abstract
OBJECTIVE: In this study we aimed to evaluate risk of coronary obstruction during transcatheter aortic valve replacement and develop improved criteria based on computational modeling. METHODS: Patient specific 3-dimensional models were constructed and validated for 28 patients out of 600 patients who were flagged as high risk for coronary obstruction (defined as meeting coronary ostium height < 14 mm and/or sinus of Valsalva diameter [SOVd] < 30 mm). The models consisted finite element analysis to predict the post- transcatheter aortic valve replacement native cusp apposition relative to the coronary ostium and were validated in vitro. The distance from cusp to coronary ostium (DLC) was derived from the 3-dimensional models and indexed with the coronary artery diameter to yield a fractional obstruction measure (DLC/d). RESULTS: Twenty-two out of 28 high-risk patients successfully underwent transcatheter aortic valve replacement without coronary obstruction and 6 did not. DLC/d between the 2 groups was significantly different (P < .00078), whereas neither coronary ostium height nor SOVd were significantly different (P > .32). A cutoff of DLC/d < 0.7 was predictive with 100% sensitivity and 95.7% specificity. The optimal sensitivity and specificity of coronary ostium height and SOVd in this high-risk group was only 60% and 40%, respectively, for cutoff coronary ostium height of 10 mm and SOVd of 30.5 mm. CONCLUSIONS: Three-dimensional modeling has the potential to enable more patients to be safely treated with transcatheter aortic valve replacement who have a low-lying coronary ostium or small SOVd. DLC/d is more predictive of obstruction than coronary ostium height and SOVd.
OBJECTIVE: In this study we aimed to evaluate risk of coronary obstruction during transcatheter aortic valve replacement and develop improved criteria based on computational modeling. METHODS:Patient specific 3-dimensional models were constructed and validated for 28 patients out of 600 patients who were flagged as high risk for coronary obstruction (defined as meeting coronary ostium height < 14 mm and/or sinus of Valsalva diameter [SOVd] < 30 mm). The models consisted finite element analysis to predict the post- transcatheter aortic valve replacement native cusp apposition relative to the coronary ostium and were validated in vitro. The distance from cusp to coronary ostium (DLC) was derived from the 3-dimensional models and indexed with the coronary artery diameter to yield a fractional obstruction measure (DLC/d). RESULTS: Twenty-two out of 28 high-risk patients successfully underwent transcatheter aortic valve replacement without coronary obstruction and 6 did not. DLC/d between the 2 groups was significantly different (P < .00078), whereas neither coronary ostium height nor SOVd were significantly different (P > .32). A cutoff of DLC/d < 0.7 was predictive with 100% sensitivity and 95.7% specificity. The optimal sensitivity and specificity of coronary ostium height and SOVd in this high-risk group was only 60% and 40%, respectively, for cutoff coronary ostium height of 10 mm and SOVd of 30.5 mm. CONCLUSIONS: Three-dimensional modeling has the potential to enable more patients to be safely treated with transcatheter aortic valve replacement who have a low-lying coronary ostium or small SOVd. DLC/d is more predictive of obstruction than coronary ostium height and SOVd.
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Authors: Ronald K Binder; John G Webb; Alexander B Willson; Marina Urena; Nicolaj C Hansson; Bjarne L Norgaard; Philippe Pibarot; Marco Barbanti; Eric Larose; Melanie Freeman; Eric Dumont; Chris Thompson; Miriam Wheeler; Robert R Moss; Tae-hyun Yang; Sergio Pasian; Cameron J Hague; Giang Nguyen; Rekha Raju; Stefan Toggweiler; James K Min; David A Wood; Josep Rodés-Cabau; Jonathon Leipsic Journal: J Am Coll Cardiol Date: 2013-05-15 Impact factor: 24.094