BAILOUT POST-TAVR PCI TECHNIQUES IN REANIMATED SWINE AND HUMAN HEARTS: PROCEDURAL IMAGING AND POST-PROCEDURAL MODELING TECHNIQUES

Transcatheter aortic valve replacement (TAVR) has become a popular treatment option for severe aortic stenosis (AS) patients who present a high risk for mortality should they receive a surgical aortic valve replacement (SAVR). Coronary artery occlusion (CAO) following the implantation of the device is a potential complication with a high mortality rate, as CAO causes a deterioration of coronary perfusion, followed by cardiogenic shock and electrical instability. Due to this dangerous potential complication, bailout percutaneous coronary intervention (PCI) techniques, like the snorkel and chimney techniques, have been developed as an effective strategy for ensuring coronary perfusion is maintained following a TAVR procedure. Both snorkel and chimney techniques have been implemented in a reanimated swine and human heart respectively utilizing Visible Heart® methodologies. The procedures have been recorded utilizing endoscopic cameras, echocardiography, optical coherence tomography, and fluoroscopy. Post-procedural micro-computed tomography (micro-CT) was conducted to provide post-implantation imaging with approximately 60-micron resolution. The reconstructions are then segmented and used to create 3D renderings of these complex procedures. These methodologies are repeatable and can be used in a variety of conditions to be used in subsequent educational uses.