Debusschere, Nic

Mortier, Peter

Nuis, Rutger Jan

Rocatello, Giorgia

van den Dorpel, Mark M.P.

Van Mieghem, Nicolas M.

English

EUR Research Repository

EUR Research Information PortalLifetime Management in Transcatheter Aortic Valve Replacement Through Patient-Specific SimulationsPublished in:JACC: Cardiovascular InterventionsPublication status and date:E-pub ahead of print: 22/01/2025DOI (link to publisher):10.1016/j.jcin.2024.11.023Document VersionVersion created as part of publication process; publisher's layout; not normally made publicly availableDocument License/Available under:CC BYCitation for the published version (APA):van den Dorpel, M. M. P., Nuis, R. J., Debusschere, N., Rocatello, G., Mortier, P., & Van Mieghem, N. M. (2025). LifetimeManagement in Transcatheter Aortic Valve Replacement Through Patient-Specific Simulations. JACC: CardiovascularInterventions, 18(8), 1060-1061. Advance online publication. https://doi.org/10.1016/j.jcin.2024.11.023Link to publication on the EUR Research Information PortalTerms and Conditions of UseExcept as permitted by the applicable copyright law, you may not reproduce or make this material available to any third partywithout the prior written permission from the copyright holder(s). Copyright law allows the following uses of this materialwithout prior permission:            • you may download, save and print a copy of this material for your personal use only;            • you may share the EUR portal link to this material.In case the material is published with an open access license (e.g. a Creative Commons (CC) license), other uses may beallowed. Please check the terms and conditions of the specific license.Take-down policyIf you believe that this material infringes your copyright and/or any other intellectual property rights, you may request itsremoval by contacting us at the following email address: openaccess.library@eur.nl. Please provide us with all the relevantinformation, including the reasons why you believe any of your rights have been infringed. In case of a legitimate complaint,we will make the material inaccessible and/or remove it from the website.IMAGES IN INTERVENTIONLifetime Management in TranscatheterAortic Valve Replacement ThroughPatient-Specific SimulationsMark M.P. van den Dorpel, MD,a Rutger-Jan Nuis, MD, PHD,a Nic Debusschere, PHD,b Giorgia Rocatello, PHD,bPeter Mortier, PHD,b Nicolas M. Van Mieghem, MD, PHDaR edo transcatheter aortic valve replacement(redo-TAVR) is emerging for treatment offailing transcatheter heart valves (THVs) butentails several challenges. Apart from the risk ofpatient–prosthesis mismatch due to the gradualdecrease in residual valve area by accumulation ofmultiple stented frame layers, redo-TAVR presents arisk of impaired postprocedural coronary access oreven coronary obstruction. Coronary ostia below theneoskirt plane and a valve-to-coronary (VTC)distance <2 mm predicts risk of coronary obstruc-tion.1-3Computed tomography–derived simulations mayprovide insights into these facets and help depictlifetime management of (younger) TAVR patients.Dedicated software (FEops, HEARTguide, FEops) in-tegrates patient-specific anatomy and physical, me-chanical THV characteristics through finite elementtechnology and can simulate subsequent THV im-plantations, enabling unique insights into coronaryaccess and residual valve areas.We present a 69-year-old patient who underwentredo-TAVR with a 23-mm balloon-expandable THV ina failing 29-mm self-expanding THV. HEARTguidesimulations were created for the index and redo-TAVR procedures, and simulation-derived, auto-matic measurements were compared with conven-tional, manual follow-up computed tomographymeasurements (Figures 1A to 1C).Index TAVR simulations accurately predicted VTCdistance but underestimated left valve-to-sinotubular-junction (VTSTJ) distance. Redo-TAVRsimulations underestimated left VTC/VTSTJ dis-tance, but overestimated right VTC/VTSTJ distance.Different positioning and canting of the THV betweensimulation and actual THV implantation may explaindifferent VTC and VTSTJ dimensions. This un-derscores the importance of considering multiplesimulations that account for variable THV positions.Additional simulations of a third TAVR procedurerevealed a high likelihood of patient–prosthesismismatch (Figure 1D), demonstrating the limitationsof sequential THV implantations and the importanceof consideration of valve surgery at some stage alongthe lifetime management of younger patients withsevere aortic stenosis.FUNDING SUPPORT AND AUTHOR DISCLOSURESDr Nuis has received research grant support from Vifor Pharma andMerill; and has received consulting fees from Edwards Lifesciences,ISSN 1936-8798 https://doi.org/10.1016/j.jcin.2024.11.023From the aDepartment of Cardiology, Cardiovascular Institute, Thoraxcenter, Erasmus University Medical Center, Rotterdam, theNetherlands; and bFEops NV, Ghent, Belgium.The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information,visit the Author Center.Manuscript received September 7, 2024; revised manuscript received November 9, 2024, accepted November 19, 2024.J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S V O L . - , N O . - , 2 0 2 5ª 2 0 2 5 T H E A U T H O R S . P U B L I S H E D B Y E L S E V I E R O N B E H A L F O F T H E AM E R I C A NC O L L E G E O F C A R D I O L O G Y F OU N D A T I O N . T H I S I S A N O P E N A C C E S S A R T I C L E U N D E RT H E C C B Y L I C E N S E ( h t t p : / / c r e a t i v e c o mm o n s . o r g / l i c e n s e s / b y / 4 . 0 / ) .Abbott, and Boston Scientific. Dr Van Mieghem has received grantsupport/research contracts from Abbott Vascular, Boston Scientific,Medtronic, Edwards Lifesciences, Daiichi-Sankyo, AstraZeneca, andPulseCath BV; and has received consulting/speaker fees from AbbottVascular, Boston Scientific Corporation, Medtronic, Daiichi-Sankyo,PulseCath BV, JenaValve, and Amgen. All other authors have reportedthat they have no relationships relevant to the contents of this paperto disclose.ADDRESS FOR CORRESPONDENCE: Prof N.M.D.A.(Nicolas) Van Mieghem, Erasmus University MedicalCenter, Department of Cardiology, Thoraxcenter,Office Nt-645, Dr. Molewaterplein 40, 3015 GD,Rotterdam, the Netherlands. E-mail: n.vanmieghem@erasmusmc.nl.RE F E RENCE S1. Forrestal BJ, Case BC, Yerasi C, et al. Riskof coronary obstruction and feasibility of coro-nary access after repeat transcatheter aorticvalve replacement with the self-expandingEvolut valve: a computed tomography simula-tion study. Circ Cardiovasc Interv. 2020;13:e009496.2. Meier D, Akodad M, Landes U, et al. Coronaryaccess following redo TAVR: impact of THVdesign, implant technique, and cell misalignment.JACC Cardiovasc Interv. 2022;15:1519–1531.3. Buzzatti N, Montorfano M, Romano V, et al.A computed tomography study of coronary accessand coronary obstruction after redo transcatheteraortic valve implantation. EuroIntervention.2020;16:e1005–e1013.KEY WORDS computer simulation,coronary access, finite element technology,transcatheter aortic valve replacementFIGURE 1 TAV Replacement Simulations(A) Top: Index transcatheter aortic valve (TAV) replacement and TAV-in-TAV simulation. Bottom: Segmentation of index TAV and redo-TAV allows validation ofsimulations by matching valve positions. (B) Annulus dimensions. (C) Valve-to-coronary (VTC) and valve-to-sinotubular-junction (VTSTJ) distances. (D) TAV-in-TAV-in-TAV simulation.van den Dorpel et al J A C C : C A R D I O V A S C U L A R I N T E R V E N T I O N S V O L . - , N O . - , 2 0 2 5Lifetime Management in TAVR Through Simulations - 2 0 2 5 :- –-2