Transcatheter Closure of a Paravalvular Leak After Transcatheter Aortic Valve Replacement With 3-Dimensional Printing Guidance: A Case Report

Abstract

Purpose:

Our goal was to report the transcatheter closure of a paravalvular leak after transcatheter aortic valve replacement (TAVR) using 3-dimensional (3D) printing.

Case Report:

A 66-year-old man who had undergone transapical and TAVR 2 years ago due to aortic regurgitation, presented with palpitations and shortness of breath owing to exacerbation of paravalvular regurgitation. Echocardiography suggested that the stented aortic valve was fixed securely in place and the valve leaflets moved normally after TAVR, but there was severe paravalvular regurgitation (3 bundles, volume 11.0 mL). Due to the high surgical risk, we closed the transcatheter paravalvular leak using preprocedural guidance with 3D printing and intraprocedural guidance with digital subtraction angiography. Postoperative echocardiography showed that the paravalvular leak was significantly reduced. 3D construction showed that the occluders and the stent valve were well placed.

Conclusion:

Transcatheter closure of a paravalvular leak of the aortic valve may be feasible with appropriate pre- and intraoperative 3D printing guidance.

Clinical Impact

3D printing technology may help surgeons to make accurate preoperative strategy before occlusion procedures.

Keywords

3D printing paravalvular leakage case report transcatheter occluder

Get full access to this article

View all access options for this article.

References

Himbert

Vahanian

Transcatheter aortic valve replacement for patients with heart failure. Heart Fail Clin. 2015;11:231–242.

Leon

Smith

Mack

, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N Engl J Med. 2016;374:1609–1620.

Manoharan

Walton

Brecker

, et al. Treatment of symptomatic severe aortic stenosis with a novel resheathable supra-annular self-expanding transcatheter aortic valve system. JACC Cardiovasc Interv. 2015;8:1359–1367.

Yang

T-H

Webb

Blanke

, et al. Incidence and severity of paravalvular aortic regurgitation with multidetector computed tomography nominal area oversizing or undersizing after transcatheter heart valve replacement with the Sapien 3: a comparison with the Sapien XT. JACC Cardiovasc Interv. 2015;8:462–471.

Thourani

Kodali

Makkar

, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: a propensity score analysis. Lancet. 2016;387:2218–2225.

Wilczek

Bujak

Reguła

, et al. Risk factors for paravalvular leak after transcatheter aortic valve implantation. Kardiochir Torakochirurgia Pol. 2015;12(2):89–94.

Kodali

Williams

Smith

, et al. Two-year outcomes after transcatheter or surgical aortic valve replacement. N Engl J Med. 2012;366:1686–1695.

Généreux

Head

Hahn

, et al. Paravalvular leak after transcatheter aortic valve replacement: the new Achilles’ heel? A comprehensive review of the literature. J Am Coll Cardiol. 2013;61:1125–1136.

Van Belle

Juthier

Susen

, et al. Postprocedural aortic regurgitation in balloon-expandable and self-expandable transcatheter aortic valve replacement procedures: analysis of predictors and impact on long-term mortality: insights from the FRANCE2 Registry. Circulation. 2014;129:1415–1427.

10.

Tanaka

Saito

Sasuga

, et al. Quantitative assessment of paravalvular leakage after transcatheter aortic valve replacement using a patient-specific pulsatile flow model. Int J Cardiol. 2018;258:313–320.

11.

Hosny

Dilley

Kelil

, et al. Pre-procedural fit-testing of TAVR valves using parametric modeling and 3D printing. J Cardiovasc Comput Tomogr. 2018;2:21–30.

12.

Zhen

Kan

Shi

, et al. Quantitative prediction of paravalvular leak in transcatheter aortic valve replacement based on tissue-mimicking 3D printing. JACC Cardiovasc Imaging. 2017;7:719–731.

13.

Feldman

Reardon

Rajagopal

, et al. Effect of mechanically expanded vs self-expanding transcatheter aortic valve replacement on mortality and major adverse clinical events in high-risk patients with aortic stenosis: the REPRISE III randomized clinical trial. JAMA. 2018;319(1):27–37.

14.

Schmauss

Schmitz

Bigdeli

, et al. Three-dimensional printing of models for preoperative planning and simulation of transcatheter valve replacement. Ann Thorac Surg. 2012;93:e31–e33.