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. 2024 May;103(6):924-933.
doi: 10.1002/ccd.31016. Epub 2024 Apr 10.

Finite element modeling with patient-specific geometry to assess clinical risks of percutaneous pulmonary valve implantation

Carly L Donahue  1 , Claire L Westman  1 , Brittany L Faanes  2 , Athar M Qureshi  3 , Victor H Barocas  1 , Varun Aggarwal  2
Affiliations

Finite element modeling with patient-specific geometry to assess clinical risks of percutaneous pulmonary valve implantation

Carly L Donahue et al. Catheter Cardiovasc Interv. 2024 May.

Abstract

Background: Percutaneous pulmonary valve implantation (PPVI) is a non-surgical treatment for right ventricular outflow tract (RVOT) dysfunction. During PPVI, a stented valve, delivered via catheter, replaces the dysfunctional pulmonary valve. Stent oversizing allows valve anchoring within the RVOT, but overexpansion can intrude on the surrounding structures. Potentially dangerous outcomes include aortic valve insufficiency (AVI) from aortic root (AR) distortion and myocardial ischemia from coronary artery (CA) compression. Currently, risks are evaluated via balloon angioplasty/sizing before stent deployment. Patient-specific finite element (FE) analysis frameworks can improve pre-procedural risk assessment, but current methods require hundreds of hours of high-performance computation.

Methods: We created a simplified method to simulate the procedure using patient-specific FE models for accurate, efficient pre-procedural PPVI (using balloon expandable valves) risk assessment. The methodology was tested by retrospectively evaluating the clinical outcome of 12 PPVI candidates.

Results: Of 12 patients (median age 14.5 years) with dysfunctional RVOT, 7 had native RVOT and 5 had RV-PA conduits. Seven patients had undergone successful RVOT stent/valve placement, three had significant AVI on balloon testing, one had left CA compression, and one had both AVI and left CA compression. A model-calculated change of more than 20% in lumen diameter of the AR or coronary arteries correctly predicted aortic valve sufficiency and/or CA compression in all the patients.

Conclusion: Agreement between FE results and clinical outcomes is excellent. Additionally, these models run in 2-6 min on a desktop computer, demonstrating potential use of FE analysis for pre-procedural risk assessment of PPVI in a clinically relevant timeframe.

Keywords: balloon testing; pulmonary valve; transcatheter; valve replacement.

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REFERENCES

    1. Hoffman JIE, Kaplan S. The incidence of congenital heart disease. J Am Coll Cardiol. 2002;39:1890‐1900. Available at: doi:10.1016/S0735-1097(02)01886-7
    1. Krasuski RA, Bashore TM. Congenital heart disease epidemiology in the United States: blindly feeling for the charging elephant. Circulation. 2016;134:110‐113.
    1. Driesen BW, Warmerdam EG, Sieswerda G‐J, et al. Percutaneous pulmonary valve implantation: current status and future perspectives. Curr Cardiol Rev. 2019;15:262‐273.
    1. Karl TR. Tetralogy of Fallot: Current surgical perspective. 2008.
    1. Shinebourne EA. Tetralogy of fallot: from fetus to adult. Heart. 2006;92:1353‐1359.

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