Realistic Vascular Replicator for TAVR Procedures
Realistic Vascular Replicator for TAVR Procedures
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DOI：
10.1007/s13239-018-0356-z
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发表时间：
2018-09-01
影响因子：
1.8
通讯作者：
Bluestein, Danny
中科院分区：
文献类型：
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作者：
Rotman, Oren M.;Kovarovic, Brandon;Bluestein, Danny
经导管主动脉瓣置换术（TAVR）是一种用于治疗重度主动脉瓣狭窄（AS）的整体手术。TAVR瓣膜通常使用简化的左心模拟器（LHS）进行测试。虽然这些瓣膜可靠地提供了基线性能，但其主动脉根部几何形状与原位解剖结构相差甚远，通常高估了瓣膜的性能。我们报告了一种新型台式患者专用动脉复制器，用于测试TAVR和培训介入心脏病专家。Replicator是人体上半身血管系统的精确模型，用于培训医生进行经皮介入治疗。它包括全自动Windkessel机制，以重现生理流动条件。制造钙化主动脉瓣模型并将其纳入复制器中，然后由经验丰富的心脏病专家使用Inovare瓣膜进行TAVR手术测试。TAVR前后监测EOA、压力和血管造影。将St. Jude机械瓣膜作为受AS解剖结构影响较小的参考瓣膜进行试验。将两种瓣膜的Replicator结果与符合ISO标准的市售LHS性能进行比较。与简化的LHS相比，Replicator中的AS解剖结构导致TAVR瓣膜性能显著降低，EOA和跨瓣压与临床数据相当。在机械瓣膜性能中观察到微小变化。Replicator被证明是TAVR测试的有效平台。与简化的几何解剖结构LHS不同，它保守地提供了临床相关的结果并对其进行了补充。Replicator对于在具有挑战性的患者解剖结构、医生培训和手术计划下测试新瓣膜最有价值。
Transcatheter aortic valve replacement (TAVR) is an over-the-wire procedure for treatment of severe aortic stenosis (AS). TAVR valves are conventionally tested using simplified left heart simulators (LHS). While those provide baseline performance reliably, their aortic root geometries are far from the anatomical in situ configuration, often overestimating the valves' performance. We report on a novel benchtop patient-specific arterial replicator designed for testing TAVR and training interventional cardiologists in the procedure. The Replicator is an accurate model of the human upper body vasculature for training physicians in percutaneous interventions. It comprises of fully-automated Windkessel mechanism to recreate physiological flow conditions. Calcified aortic valve models were fabricated and incorporated into the Replicator, then tested for performing TAVR procedure by an experienced cardiologist using the Inovare valve. EOA, pressures, and angiograms were monitored pre- and post-TAVR. A St. Jude mechanical valve was tested as a reference that is less affected by the AS anatomy. Results in the Replicator of both valves were compared to the performance in a commercial ISO-compliant LHS. The AS anatomy in the Replicator resulted in a significant decrease of the TAVR valve performance relative to the simplified LHS, with EOA and transvalvular pressures comparable to clinical data. Minor change was seen in the mechanical valve performance. The Replicator showed to be an effective platform for TAVR testing. Unlike a simplified geometric anatomy LHS, it conservatively provides clinically-relevant outcomes and complement it. The Replicator can be most valuable for testing new valves under challenging patient anatomies, physicians training, and procedural planning.