3D-Printing to Plan Complex Transcatheter Paravalvular Leaks Closure
Background: Percutaneous closure of paravalvular leak (PVL) has emerged as an alternative to surgical management in selected cases. Achieving complete PVL occlusion, while respecting prosthesis function remains challenging. A multimodal imaging analysis of PVL morphology before and during the proced...
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Published in | Journal of clinical medicine Vol. 11; no. 16; p. 4758 |
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Abstract | Background: Percutaneous closure of paravalvular leak (PVL) has emerged as an alternative to surgical management in selected cases. Achieving complete PVL occlusion, while respecting prosthesis function remains challenging. A multimodal imaging analysis of PVL morphology before and during the procedure is mandatory to select an appropriate device. We aim to explore the additional value of 3D printing in predicting device related adverse events including mechanical valve leaflet blockade, risk of device embolization and residual shunting. Methods: From the FFPP registries (NCT05089136 and NCT05117359), we included 11 transcatheter PVL closure procedures from three centers for which 3D printed models were produced. Cardiac CT was used for segmentation for 3D printed models (3D-heartmodeling, Caissargues, France). Technology used a laser to fuse very fine powders (TPU Thermoplastic polyurethane) into a final part-laser sintering technology (SLS) with an adapted elasticity. A simulation on 3D printed model was performed using a set of occluders. Results: PVLs were located around aortic prostheses in six cases, mitral prostheses in four cases and tricuspid ring in one case. The device chosen during the simulation on the 3D printed model matched the one implanted in eight cases. In the three other cases, a similar device type was chosen during the procedures but with a different size. A risk of prosthesis leaflet blockade was identified on 3D printed models in four cases. During the procedure, the occluder was removed before release in one case. In another case the device was successfully repositioned and released. In two patients, leaflet impingement was observed post-operatively and surgical device removal had to be performed. Conclusion: In a case-series of complex transcatheter PVL closure procedures, hands-on simulation testing on 3D printed models proved its usefulness to plan and facilitate these challenging procedures. |
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AbstractList | BACKGROUNDPercutaneous closure of paravalvular leak (PVL) has emerged as an alternative to surgical management in selected cases. Achieving complete PVL occlusion, while respecting prosthesis function remains challenging. A multimodal imaging analysis of PVL morphology before and during the procedure is mandatory to select an appropriate device. We aim to explore the additional value of 3D printing in predicting device related adverse events including mechanical valve leaflet blockade, risk of device embolization and residual shunting. METHODSFrom the FFPP registries (NCT05089136 and NCT05117359), we included 11 transcatheter PVL closure procedures from three centers for which 3D printed models were produced. Cardiac CT was used for segmentation for 3D printed models (3D-heartmodeling, Caissargues, France). Technology used a laser to fuse very fine powders (TPU Thermoplastic polyurethane) into a final part-laser sintering technology (SLS) with an adapted elasticity. A simulation on 3D printed model was performed using a set of occluders. RESULTSPVLs were located around aortic prostheses in six cases, mitral prostheses in four cases and tricuspid ring in one case. The device chosen during the simulation on the 3D printed model matched the one implanted in eight cases. In the three other cases, a similar device type was chosen during the procedures but with a different size. A risk of prosthesis leaflet blockade was identified on 3D printed models in four cases. During the procedure, the occluder was removed before release in one case. In another case the device was successfully repositioned and released. In two patients, leaflet impingement was observed post-operatively and surgical device removal had to be performed. CONCLUSIONIn a case-series of complex transcatheter PVL closure procedures, hands-on simulation testing on 3D printed models proved its usefulness to plan and facilitate these challenging procedures. Background: Percutaneous closure of paravalvular leak (PVL) has emerged as an alternative to surgical management in selected cases. Achieving complete PVL occlusion, while respecting prosthesis function remains challenging. A multimodal imaging analysis of PVL morphology before and during the procedure is mandatory to select an appropriate device. We aim to explore the additional value of 3D printing in predicting device related adverse events including mechanical valve leaflet blockade, risk of device embolization and residual shunting. Methods: From the FFPP registries (NCT05089136 and NCT05117359), we included 11 transcatheter PVL closure procedures from three centers for which 3D printed models were produced. Cardiac CT was used for segmentation for 3D printed models (3D-heartmodeling, Caissargues, France). Technology used a laser to fuse very fine powders (TPU Thermoplastic polyurethane) into a final part-laser sintering technology (SLS) with an adapted elasticity. A simulation on 3D printed model was performed using a set of occluders. Results: PVLs were located around aortic prostheses in six cases, mitral prostheses in four cases and tricuspid ring in one case. The device chosen during the simulation on the 3D printed model matched the one implanted in eight cases. In the three other cases, a similar device type was chosen during the procedures but with a different size. A risk of prosthesis leaflet blockade was identified on 3D printed models in four cases. During the procedure, the occluder was removed before release in one case. In another case the device was successfully repositioned and released. In two patients, leaflet impingement was observed post-operatively and surgical device removal had to be performed. Conclusion: In a case-series of complex transcatheter PVL closure procedures, hands-on simulation testing on 3D printed models proved its usefulness to plan and facilitate these challenging procedures. |
Author | Lebret, Emmanuel Hascoet, Sebastien Gerardin, Benoit Maupas, Eric Batistella, Marcos Ciobotaru, Vlad Gallet, Romain Tadros, Victor-Xavier Decante, Benoit |
AuthorAffiliation | 3 IMT, Mines Telecom Institute, 30319 Ales, France 1 Structural and Valvular Unit, Hôpital Privé les Franciscaines, 7 Rue Jean Bouin, 30000 Nîmes, France 2 Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Inserm UMR-S 999, BME Lab, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France 4 Cardiology Unit, Hôpital Henri Mondor (AP-HP), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France |
AuthorAffiliation_xml | – name: 1 Structural and Valvular Unit, Hôpital Privé les Franciscaines, 7 Rue Jean Bouin, 30000 Nîmes, France – name: 4 Cardiology Unit, Hôpital Henri Mondor (AP-HP), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France – name: 2 Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Inserm UMR-S 999, BME Lab, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France – name: 3 IMT, Mines Telecom Institute, 30319 Ales, France |
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Cites_doi | 10.1016/j.jacc.2017.02.038 10.1007/s11886-021-01571-7 10.1093/eurheartj/ehab395 10.1016/j.jcmg.2019.12.022 10.1016/j.acvd.2018.04.005 10.1016/j.acvd.2018.05.001 10.1161/CIRCULATIONAHA.116.022684 10.1016/j.jaccas.2021.08.017 10.4244/EIJ-D-17-00970 10.4244/EIJ-D-16-00581 10.1016/j.ijcchd.2021.100161 10.4244/EIJ-D-19-00517 10.1016/j.jacc.2011.07.041 10.1016/j.jcmg.2017.04.005 10.1016/j.jcct.2014.07.001 10.1016/j.jcct.2019.03.008 10.1016/j.jacc.2020.11.035 10.1093/eurheartj/ehaa292 10.1093/eurheartj/ehz748.0768 10.1016/j.media.2021.102222 10.1186/s13019-020-01255-3 |
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Keywords | multimodality imaging percutaneous paravalvular leak transcatheter interventional cardiology 3D printing prosthetic valve |
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Snippet | Background: Percutaneous closure of paravalvular leak (PVL) has emerged as an alternative to surgical management in selected cases. Achieving complete PVL... BACKGROUNDPercutaneous closure of paravalvular leak (PVL) has emerged as an alternative to surgical management in selected cases. Achieving complete PVL... |
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SubjectTerms | 3-D printers Bioengineering Cardiology and cardiovascular system Clinical medicine Embolization Human health and pathology Lasers Life Sciences Patients Prostheses Simulation Success Surgery |
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Title | 3D-Printing to Plan Complex Transcatheter Paravalvular Leaks Closure |
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