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Session: Cardiovascular diseases
Session starts: Friday 25 January, 13:00
Presentation starts: 13:30
Room: Lecture room 558

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Roel Meiburg (Eindhoven University of Technology)
Jorn J.D. Roijen (Eindhoven University of Technology)
Sjors J.A. van Velthoven (Eindhoven University of Technology)
Jo M. Zelis (Catharina Ziekenhuis Eindhoven)
Marcel C.M. Rutten (Eindhoven University of Technology)
Frans F.N. van de Vosse (Eindhoven University of Technology)

Abstract:
Aortic stenosis (AS) is a degenerative valve disease, where the leaflets stiffen due to calcifications and thickening, leading to a reduction in blood flow from the heart. It affects mainly the elderly, meaning that possibility of adverse effects of (surgical) treatment becomes a significant parameter in the treatment decision process. For patients who are excluded from surgical procedures, e.g., due to frailty, transcatheter aortic valve implantation (TAVI) is a minimally invasive alternative. In TAVI, a replacement valve is delivered via a catheter and placed over the diseased valve. While TAVI is generally successful, adverse effects such as post-placement leakage or even annulus rupture can occur, resulting in minimal patient improvement or even death. A 3D printed valve model can help clinicians in several ways. First, it allows them to more easily and intuitively inspect the valve. Second, by placing the valve inside a mock-circulation, it allows them to test the TAVI-procedure and assess the outcome. Finally, it can be used as a training tool, as it allows practice and easy assessment of TAVI placement. For 14 AS patients, CT and US images were obtained, along with pressure measurements inside the left ventricle and aorta, and thermo-dilution cardiac output measurements. The geometry of the stenotic valve was obtained by segmenting the aortic valve and root from CT data. The geometry is then digitally placed inside a cylindrical shape, so that it can be housed inside the mock circulation. A negative mould is then created using a 3D-printer. The final valve is created by injection moulding, using a soft, two-component silicone compound. Since the valve is segmented and printed in the closed position, the leaflets are separated based on transverse ultrasound images, using a scalpel. The valve is then placed inside the mock circulation, which is tuned to the patient’s data, leading to a patient specific in vitro simulator of the AS patient. The TAVI procedure is then performed, monitored via US and captured with a camera inside the aortic root. Afterwards, the change in haemodynamics and the success of the placement can be assessed. This way, the procedural outcome can be evaluated prior to the actual treatment, and possible valve consistency-related may be mitigated.