VR before TAVR predicts paravalvular leak in high-risk patients
![Virtual reality (VR) can help cardiologists plan for transcatheter aortic valve replacement (TAVR) procedures and predict the presence and severity of post-TAVR paravalvular leak (PVL), according to new research published in the Journal of Invasive Cardiology.[1]](/sites/default/files/styles/top_stories/public/2024-03/screen_shot_2024-03-25_at_4.04.23_pm.png.webp?itok=h9Xhn__d)
Virtual reality (VR) can help cardiologists plan for transcatheter aortic valve replacement (TAVR) procedures and predict the presence and severity of post-TAVR paravalvular leak (PVL), according to new research published in the Journal of Invasive Cardiology.[1]
“Emerging medical technologies such as 3D printing and digital modeling have shown promise in pre-procedure planning for TAVR in severe tricuspid aortic stenosis (AS),” wrote first author Johnny Chahine, MD, a cardiologist with Cleveland Clinic who was at the University of Minnesota Medical School at the time of this analysis, and colleagues. “VR is another emerging technology that has been primarily utilized as a teaching tool in surgical subspecialties with various successes. However, VR has not been utilized in TAVR planning and has never been used in the pre-procedural planning of patients with severe bicuspid AS at high risk of TAVR complications.”
Chahine et al. noted that VR is quick, intuitive and cost-effective, three factors that suggest it would be a great fit for TAVR programs. To evaluate its effectiveness, they tracked data from 22 patients with severe bicuspid aortic valve (BAV) stenosis who originally underwent TAVR from 2014 to 2018 at a single facility. The median age was 78 years old, and nine patients were women. While 12 patients received a balloon-expandable TAVR valve, the other 10 received a self-expanding TAVR valve.
For each patient, specialists performed VR simulations using a headset from Valve and medical image processing software from Realize Medical. The simulation was built using CT images and included the same TAVR valve as the actual procedure when it originally occurred. Each simulation was then assessed for the presence, location and severity of malapposition, and those data were compared with post-procedural PVL as captured by echocardiography.
Overall, the group found that VR simulations developed using CT data accurately predicted the presence or lack of PVL for all 22 patients. PVL was present in five cases, for instance, and the VR predicted it would be there in all five cases. Likewise, PVL was absent in the other 17 cases, and the VR predicted it would be absent each time. According to the simulations, the median oversizing was 16.3% for balloon-expandable valves and 7.9% for self-expanding valves.
The VR simulations had an area under the ROC curve (AUC) of 0.83 when it came to identifying malapposition. This was higher than the AUC Chahine et al. calculated for annular calcium (0.65), calcified raphe (0.58) and the annular eccentricity index.
According to the research team, these findings supported the initial hypothesis that VR simulations can help predict when PVL may be an issue following TAVR. There are multiple limitations to this analysis, including its small sample size and the fact that it only included data from a single facility, but the study findings suggest VR could make a big impact on TAVR care in the United States in the near future.
“VR is changing the medical landscape and may be the solution to future cost-effective periprocedural planning to reduce complications, guide valve size and selection and streamline procedures,” the authors wrote. “Future routine implementation of additional algorithms to simulate tissue elasticity as well as computational fluid dynamics can augment the VR simulation with realistic interactions and hemodynamic assessment of valves, including post-procedural gradients, PVL quantification, and early identification of leaflet thrombosis.”
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.