15. Modeling of Valve-in-Valve Transcatheter Aortic Valve Implantation after Aortic Root Replacement Using 3-Dimensional Artificial Intelligence Algorithm

Objective: Aortic root replacement requires reimplantation of coronary arteries and the construction of the composite valve graft, which may involve an angled supra-coronary aortic anastomosis. This study aimed to assess the feasibility of valve-in-valve transcatheter aortic valve implantation after bioprosthetic root replacement.

Methods: A retrospective review was conducted on 74 consecutive patients who underwent root replacement at a single institution from October 10, 2019 to October 19, 2021. Forty patients underwent bioprosthetic root replacement and had postoperative computed tomographic angiography scans. Computational simulations of transcatheter valve deployment were performed using both balloon and self-expanding valves. This dynamic, computational model assessing post deployment anatomy was then compared to traditional, manually measured valve-to-coronary distances from computed tomography scans to determine safety and feasibility of deployment.

Results: For the right coronary artery, the mean model and manual coronary distances were 14.09 mm and 4.86 mm for the balloon-expanding valve and 14.2 mm 6.85 mm for the self-expanding valve. For the left coronary artery, the mean distances were 10.6 mm and 5.06 mm for the balloon-expanding valve and 12.0 mm and 7.30 mm for the self-expanding valve. Per the model, one patient was at risk for right coronary obstruction using a balloon-expandable valve. No patients were at risk of coronary obstruction with a self-expanding valve (Figure A). Five patients (5/40) had simulated valve stent deformation with a self-expanding valve (Figure B). Overall, 98% (39/40) of patients were candidates for balloon-expanding valves and 88% (35/40) of patients were candidates for self-expanding valves.

Conclusions: Following aortic root replacement, all patients are candidates for valve-in-valve using one or both types of transcatheter heart valves. Self-expanding valves may be at higher risk for stent frame deformation at graft anastomotic lines, and balloon-expandable valves may be at higher risk of coronary obstruction. Surgeons can optimize for transcatheter aortic reinterventions with high coronary reimplantation and avoidance of an angled aortic graft anastomosis.

Aaron Clark (1), Taylor Sirset-Becker (2), James Flaherty (1), Christopher Mehta (1), Bradley Allen (1), Patrick McCarthy (1), Duc Thinh Pham (1), Andrei Churyla (1), Lakshmi Dasi (3), S. Chris Malaisrie (1), (1) Northwestern Memorial Hospital, Chicago, IL, (2) The Ohio State University School of Medicine, Columbus, OH, (3) Georgia Institute of Technology & Emory University, Atlanta, GA

Friedhelm Beyersdorf

Commentator

Friedhelm Beyersdorf, born in 1954 went to Medical School from 1975 - 1981 in Frankfurt/M., Germany and included clinical clerkships at the Johns Hopkins University Baltimore and the Thomas Jefferson Medical College, Phildelphia. He passed the German and US Boards Part I and II and got `summa cum laude´ for his doctoral thesis in 1981. He accomplished is postgraduate training in Thoracic and Cardiovascular Surgery in Frankfurt and his Research Training from 1984-1985 at the Department of Cardio-Thoracic Surgery at the University of California, Los Angeles with Dr. Gerald D. Buckberg. He passed the Boards of General, Cardiothoracic and Vascular Surgery.

He was appointed full Professor of Cardiovascular Surgery at the Albert-Ludwigs-University Freiburg in 1994 and served as the Chairman of the Department from 1994 - 2022. He developed his Department into one of the most busiest ones in Germany with finally 8 ORs and 4,500 cardiac and vascular cases/year, including the full spectrum of pediatric and adult cardiovascular surgery, heart, heart-lung and lung transplantations, mechanical circulatory assist devices and total artificial hearts, and a very busy aortic program. He received the title as Professor honoris causa in 2000 and Doctor honoris causa in 2008 and founded the Charity Organisation `Kinderherzen retten e.V.`(Save the Children´s Hearts) in 2002 and the Start-up Company `Resuscitec `from the University in Freiburg in 2010.

He served as the President of the German Society for Thoracic and Cardiovascular Surgery (DGTHG) from 2009 - 2011, as the Editor-in-Chief of the European Journal of Cardio-Thoracic Surgery (EJCTS) and the Interactive  Cardiovascular and Thoracic Surgery (ICVTS) from 2010 - 2020 and as the President of the European Association for Cardio-Thoracic Surgery (EACTS) from 2021 - 2022. He received numerous national and international awards.

 

 

 

Aaron Clark

Abstract Presenter

I attended Indiana University School of Medicine and graduated in 2019. I am curently a PGY5 in the cardiothoracic residency at Northwestern University. I'm interested in structural heart disease including surgical and transcatheter interventions as well as aortic aneurysm and repair.