Patient-Specific Computer Simulation to Predict Conduction Disturbance With Current-Generation Self-Expanding Transcatheter Heart Valves

Editorial: Preprocedural Computational Modeling — One More Step Toward Precision Medicine in Transcatheter Aortic Valve Replacement?

“…In this new study, Dowling et al. 4 could confirm that the computer simulations could predict major conduction disturbances with acceptable diagnostic performance when simulating current-generation devices. Interestingly, the optimal threshold of the CPI to predict major conduction disturbance was slightly higher (CPI ≥20%) than previously reported; this might be attributable to differences in the design of the current-generation Evolut PRO THV, which has an outer pericardial sealing skirt.…”

“…In this issue of Structural Heart, Dowling et al. 4 report on the performance of computed tomography–based computer-simulated contact pressure calculations to predict major conduction disturbances after TAVR. In a correct, retrospectively designed study in 80 patients, the authors modeled the contact pressure index (CPI) and maximal contact pressure (CPmax) of the implanted THV and measured at a predefined region of interest containing the atrioventricular conduction system.…”

“… 6 The authors also sought to examine whether computer simulations could identify patients at risk for prolonged hospitalization and long-term adverse clinical outcomes. 4 However, the further the studied outcomes are ‘distanced’ from the pure host-device interaction modeling and the more other variables also impact these clinical outcomes, the less diagnostic accuracy can be expected of these computer simulations.…”

Combining Cell Technologies With Biomimetic Tissue Engineering Applications: A New Paradigm for Translational Cardiovascular Therapies

“…In this context, computational models could foresee the effect of the patient’s specific anatomy on the success rate of the intervention, helping a tailored pre-operative planning and post-operative assessment of the surgical intervention. 57-59 To conclude, besides focusing on the development of computational models regarding the specific behavior of (healthy) ECM-producing cells, it is also important to model how cell-mediated growth and remodeling interact with other regenerative processes as a function of patient-specific conditions. Ultimately, such models studying complex cellular interactions could easily be adapted to stem cell-based biomimetic TE therapies, often by relatively straightforward adjustments to the parameter space.…”

‘The Digital Cardiologist’: How Technology Is Changing the Paradigm of Cardiology Training

“…to improve anatomical understanding and surgical preparedness, improved understanding of spatial relationships and allowed operators to simulate surgical strategies (25). It can also help predict and prevent recognised complications of specific procedures, such as heart block following TAVI procedures (26). Also exciting within the structural space is the expanding role of remote proctoring using augmented reality (AR).…”