Multimodal Imaging of a Chimney-Stenting Procedure Performed Simultaneously with a Transcatheter Aortic Valve Replacement (TAVR) in a Reanimated Human Heart including Post-Implant Analyses

Michael A. Bielecki, Amanda N. DeVos, Francesco Bianchini, Paul A. Iaizzo

Research output: Contribution to journalArticlepeer-review

1 Scopus citations

Abstract

Transcatheter aortic valve replacement (TAVR) has become a popular treatment option for severe aortic stenosis for patients with a high risk for mortality with surgical aortic valve replacement (SAVR). Coronary artery occlusion (CAO) following the implantation of the device is a potential and sometimes devastating complication of this procedure, that provokes a sudden deterioration of hemodynamic status followed by cardiogenic shock and electrical instability. With patients that present a high risk for coronary obstruction, coronary protection with a chimney stenting technique is an effective strategy that can ensure coronary perfusion during TAVR in case of acute CAO. Utilizing Visible Heart® methodologies, a human heart was reanimated. A chimney stenting technique was implemented simultaneously with the deployment of a Medtronic Evolut Pro+ valve (Medtronic PLC; Minneapolis, MN, USA). The entire procedure was recorded utilizing endoscopic cameras, fluoroscopy, optical coherence tomography, and echocardiography. In addition to these procedural visualizations, post-procedural micro-computed tomography (micro-CT) was conducted to provide post-implantation imaging with approximately 60-micron resolution. Utilizing these imaging modalities in a reanimated human heart allows for the unique opportunity to collect data for TAVR procedures in real human anatomies for the subsequent educational uses by the physicians treating aortic valvular disease and/or the designers of future TAVR technologies and procedures.

Original languageEnglish (US)
Article number413
JournalJournal of Cardiovascular Development and Disease
Volume9
Issue number12
DOIs
StatePublished - Dec 2022

Bibliographical note

Funding Information:
This research was supported in part by the University of Minnesota’s Institute for Engineering in Medicine, an Education Grant from the University’s Medical School, and a research contract from Medtronic.

Publisher Copyright:
© 2022 by the authors.

Keywords

  • Evolut Pro+
  • chimney
  • computational reconstructions
  • deployment
  • micro-computed tomography (micro-CT)
  • percutaneous coronary intervention (PCI)
  • post-TAVR PCI
  • post-procedural imaging
  • transcatheter aortic valve replacement (TAVR)

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