How patient-specific simulations can improve TAVR care
Patient-specific computer simulations can lead to changes in transcatheter aortic valve replacement (TAVR) procedures, according to a new study published in JACC: Cardiovascular Interventions. The findings come as TAVR continues to gain popularity.
“As TAVR shifts toward low-risk patients, optimal outcome and prevention of complications may become more important given the projected longevity in younger and/or less sick patients,” wrote lead author Nahid El Faquir, MD, Erasmus Medical Center in the Netherlands, and colleagues. “A patient-specific approach is recommended and needed in such an environment to optimize health benefit.”
Researchers explored the impact of using TAVIguide software to simulate TAVR before the actual procedure. TAVIguide was designed to predict the patient’s TAVR outcome, though more research is still needed to confirm its accuracy.
The observational study focused on 80 patients with severe aortic stenosis who were to be treated with the Evolut R system—the patient-specific simulation was used to predict outcomes for 42 patients, and the remaining 38 patients were used as simulation-free controls. All patients underwent pre-discharge transthoracic echocardiography, and the images were interpreted by independent specialists.
Overall, the simulations inspired clinicians to change part of the treatment plan for 16 of 42 patients. One of the team’s primary interests was how the simulations may impact a clinician’s valve size selection—and, it turns out, it made no impact in that area. However, the authors identified “more profound effects” when it came to affecting the target depth of implantation and the execution of TAVR to achieve the desired target depth of implantation.
Also, the authors noted, the simulation did not appear to impact the valve performance or conduction abnormalities.
According to the authors, these findings offer a promising glimpse at how patient-specific simulations can help clinicians as they treat TAVR patients.
“As TAVR moves toward low-risk patients and rapidly expands, becoming the mainstream treatment for aortic stenosis, in addition to the expansion of centers performing TAVR with varying degrees of experience and the emergence of new valve manufacturers, it is conceivable that patient-specific computer simulation may be either provided by manufacturers as a service to physicians, ensuring outcomes, or by the operator in particular in case of a small experience,” the authors wrote. “The inclusion of deep learning may serve to further automate the process of procedural planning and may enhance this process.”
Michael has more than 18 years of experience as a professional writer and editor. He has written at length about cardiology, radiology, artificial intelligence and other key healthcare topics.