3D-Printing to Plan Complex Transcatheter Paravalvular Leaks Closure

Abstract

Background: Percutaneous closure of paravalvular leak (PVL) has emerged as an alternative to surgical management in selected cases. Achieving complete PVL occlusion, while respecting prosthesis function remains challenging. A multimodal imaging analysis of PVL morphology before and during the procedure is mandatory to select an appropriate device. We aim to explore the additional value of 3D printing in predicting device related adverse events including mechanical valve leaflet blockade, risk of device embolization and residual shunting. Methods: From the FFPP registries (NCT05089136 and NCT05117359), we included 11 transcatheter PVL closure procedures from three centers for which 3D printed models were produced. Cardiac CT was used for segmentation for 3D printed models (3D-heartmodeling, Caissargues, France). Technology used a laser to fuse very fine powders (TPU Thermoplastic polyurethane) into a final part-laser sintering technology (SLS) with an adapted elasticity. A simulation on 3D printed model was performed using a set of occluders. Results: PVLs were located around aortic prostheses in six cases, mitral prostheses in four cases and tricuspid ring in one case. The device chosen during the simulation on the 3D printed model matched the one implanted in eight cases. In the three other cases, a similar device type was chosen during the procedures but with a different size. A risk of prosthesis leaflet blockade was identified on 3D printed models in four cases. During the procedure, the occluder was removed before release in one case. In another case the device was successfully repositioned and released. In two patients, leaflet impingement was observed post-operatively and surgical device removal had to be performed. Conclusion: In a case-series of complex transcatheter PVL closure procedures, hands-on simulation testing on 3D printed models proved its usefulness to plan and facilitate these challenging procedures.

Real-Time Three-Dimensional Transesophageal Echocardiography Outperforms Three-Dimensional Printing in Detecting Multiple Perivalvular Leaks after Mitral Valve Replacement：A Case Report and Literature Review

“…In cases where the above technology is not available, TEE can provide an advantage over 3D printing [21] . For example, in cases of multiple mitral PVLs, a new innovative diagnostic approach involves combining RT-3D TEE with a 3D printed model during surgery.…”

3D printing from transesophageal echocardiography for planning mitral paravalvular leak closure – feasibility study

“…In our study, we confirmed the feasibility of using 3D-printed mitral valve models to simulate PVL closure procedures, relying on data obtained from 3D-TEE imaging. Up until now, the literature has primarily focused on discussing the potential of CT images for 3D model preparation and transcatheter PVL closure [ 15 , 21 – 24 ]. Our study adds to the existing knowledge by showing the practical application and benefits of 3D-printed mitral valve models in simulating PVL closure procedures, providing valuable insights for further advancements in this field.…”

“…As the use of real-time 3D color Doppler imaging enables exact localization of the PVL it seems reasonable to use TEE data for 3D printed models. There are reports of using TEE-based 3D printings for cardiac interventional procedures [14,15]. However, the preparation of 3D models from echocardiographic data is more challenging in comparison to CT due to lack of compatibility between echocardiographic (non-Cartesian) DICOM data and software used for stereolithography model preparation [16][17][18][19].…”

Aortic Valve Engineering Advancements: Precision Tuning with Laser Sintering Additive Manufacturing of TPU/TPE Submillimeter Membranes

“…The procedure for obtaining the valve models has been previously described [29]. In brief, we performed intensity-based segmentation using Philips IntelliSpace Portal V11 (Philips, Best, The Netherlands) on cardiac ECG-synchronized CT scan.…”