Toward predictive modeling of catheter-based pulmonary valve replacement into native right ventricular outflow tracts

Matthew A. Jolley, Andras Lasso, Hannah H. Nam, Patrick V. Dinh, Adam B. Scanlan, Alex V. Nguyen, Anna Ilina, Brian Morray, Andrew C. Glatz, Francis X. McGowan, Kevin Whitehead, Yoav Dori, Joseph H. Gorman, Robert C. Gorman, Gabor Fichtinger, Matthew J. Gillespie

Research output: Contribution to journalArticlepeer-review

9 Scopus citations

Abstract

Background: Pulmonary insufficiency is a consequence of transannular patch repair in Tetralogy of Fallot (ToF) leading to late morbidity and mortality. Transcatheter native outflow tract pulmonary valve replacement has become a reality. However, predicting a secure, atraumatic implantation of a catheter-based device remains a significant challenge due to the complex and dynamic nature of the right ventricular outflow tract (RVOT). We sought to quantify the differences in compression and volume for actual implants, and those predicted by pre-implant modeling. Methods: We used custom software to interactively place virtual transcatheter pulmonary valves (TPVs) into RVOT models created from pre-implant and post Harmony valve implant CT scans of 5 ovine surgical models of TOF to quantify and visualize device volume and compression. Results: Virtual device placement visually mimicked actual device placement and allowed for quantification of device volume and radius. On average, simulated proximal and distal device volumes and compression did not vary statistically throughout the cardiac cycle (P = 0.11) but assessment was limited by small sample size. In comparison to actual implants, there was no significant pairwise difference in the proximal third of the device (P > 0.80), but the simulated distal device volume was significantly underestimated relative to actual device implant volume (P = 0.06). Conclusions: This study demonstrates that pre-implant modeling which assumes a rigid vessel wall may not accurately predict the degree of distal RVOT expansion following actual device placement. We suggest the potential for virtual modeling of TPVR to be a useful adjunct to procedural planning, but further development is needed.

Original languageEnglish
Pages (from-to)E143-E152
JournalCatheterization and Cardiovascular Interventions
Volume93
Issue number3
DOIs
StatePublished - Feb 15 2019

Keywords

  • magnetic resonance imaging
  • percutaneous pulmonary valve implantation
  • prosthetic heart valve
  • tetralogy of Fallot

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