Use of Patient-Specific 3-Dimensional Printed Models for Planning a Valve-in-Valve Transcatheter Aortic Valve Replacement and Educating Health Personnel, Patients, and Families

• Published in: The Ochsner journal 2021, Vol.21 (1), p.93-98
• Main Authors: Soto, Jose D Tafur, Betancourt, Silvia Patricia Gironza
• Format: Article
• Language: English
• Subjects: Case Reports and Clinical Observations
• ISSN: 1524-5012; 1524-5012
• DOI: 10.31486/toj.19.0106

Aortic stenosis is a common disease of the elderly. Valve replacement with open surgery is the preferred therapy for many patients with low surgical risk. Bioprosthetic valve failure occurs in up to 66% of patients and has a worse prognosis when the mechanism of failure is stenosis compared to regurgitation. An 80-year-old female with a medical history of surgical aortic valve replacement, diabetes, chronic back pain, coronary artery disease, and hypertension was referred to the interventional cardiology clinic for heart failure symptoms. A bioprosthetic valve placement that was small for the patient's size (effective orifice area/body surface area 0.75 cm /m ) resulted in symptomatic improvement that lasted for 7 years. The patient underwent an aortic valve-in-valve transcatheter valve replacement with excellent outcomes. Preoperative planning involved a patient-specific 3-dimensional printed patient model. In patients at high surgical risk, transcatheter aortic valve replacement is a fundamental pillar of treatment. However, valve-in-valve procedures have specific anatomic challenges, such as the risk of coronary artery obstruction and the limitation of valve expansion inside a rigid bioprosthetic valve frame. In those difficult cases, interventional cardiologists must make precise decisions regarding the approach. Three-dimensional models can be printed with the patient's specific measurements. This approach represents truly personalized medicine and can serve as a tool for procedural planning, education of the health personnel involved in the case, and patient and family engagement.