Implantation of a self-expanding transcatheter valve in vitro into a 3D heart model of a patient with right ventricular outflow tract dysfunction

Introduction. Transcatheter pulmonary valve implantation is one of the most relevant issues in endovascular surgery for congenital heart defects. However, at present, there is no “ideal” valve for transcatheter implantation. Balloon-expandable pulmonary valves for transcatheter implantation have a rigid frame, which requires pre-stenting of the native right ventricular outflow tract or the valve-containing conduit to avoid perioperative complications. This tactic increases the procedure time, complicates the valve implantation technique, and raises the cost of the operation. Self-expanding valves, which are primarily aimed at addressing pulmonary regurgitation, present an alternative. Determining an adequate implantation zone for the valve is crucial for the successful treatment of a dilated native right ventricular outflow tract. This is why preoperative CT imaging protocol, with 3D reconstruction providing detailed anatomical structures at every level, plays a significant role.

Aims. To assess the properties of the transcatheter self-expanding frame of the pulmonary artery valve and to perform its in vitro implantation in a 3D model of a patient with right ventricular outflow tract dysfunction.

Material and Methods. We developed a model of a self-expanding nitinol frame for a transcatheter valve for implantation in the position of the pulmonary artery, based on the most commonly encountered anatomy of right ventricular outflow tract dysfunction. We conducted tests for radial forces of the frame and valve loading trials in the delivery system. Results. A 3D reconstruction of the right heart chambers with the inferior vena cava was performed, with detailed anatomical structure delineation at each level. A 3D model was printed on an SLA 3D printer, Formlabs Form 3B+, using Elastic 50A photopolymer (Formlabs Inc., USA). Under fluoroscopic guidance, a test implantation of the pulmonary artery valve frame was carried out.

Conclusion. By optimizing the design of the supporting frame, we were able to improve the transcatheter valve frame model based on the analysis of the most common right ventricular outflow tract dysfunctions. 3D-printed constructs enable the safe testing of developing transcatheter valve models and help identify and timely address any existing deficiencies.

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