AccScience Publishing / JCTR / Online First / DOI: 10.36922/jctr.24.00084
Submit to JCTR
Cite this article
1
Download
43
Views
Journal Browser
Volume | Year
Issue
Search
Forthcoming Issue
Current Issue
View All
News and Announcements
View All
ORIGINAL ARTICLE

Three-dimensional printing-guided coaxiality assessment in transcatheter aortic valve replacement for aortic regurgitation

Yu Mao1 ,  Yang Liu1 ,  Yanyan Ma1 ,  Zhenge Fan1 ,  Mengen Zhai1 ,  Yiwei Wang1 ,  Ping Jin1 ,  Yingqiang Guo2 ,  Gejun Zhang3 ,  Haibo Zhang4 ,  Lai Wei5 ,  Jian Liu6 ,  Fangyao Chen7 ,  Yuhui Yang7 ,  Xiangbin Pan3 ,  Jian Yang1*
Show Less
1 Department of Cardiovascular Surgery, Xijing Hospital, Xi’an, Shaanxi, China
2 Department of Cardiovascular Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan, China
3 Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
4 Department of Cardiovascular Surgery, Anzhen Hospital, Capital Medical University, Beijing, China
5 Department of Cardiovascular Surgery, Shanghai Cardiovascular Institution and Zhongshan Hospital, Fudan University, Shanghai, China
6 Department of Cardiovascular Surgery, Guangdong Provincial People’s Hospital, Guangzhou, Guangdong, China
7 Department of Epidemiology and Biostatistics, School of Public Health, Xi’an Jiaotong University Health Science Center, Xi’an, Shaanxi, China
JCTR, 00084 https://doi.org/10.36922/jctr.24.00084
Received: 26 December 2024 | Revised: 14 April 2025 | Accepted: 29 April 2025 | Published online: 26 June 2025
© 2025 by the Author(s). This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution -Noncommercial 4.0 International License (CC-by the license) ( https://creativecommons.org/licenses/by-nc/4.0/ )
Download PDF
Cite
XML
Abstract

Background: Transcatheter aortic valve replacement (TAVR) using the J-Valve system provides a solution for patients with aortic regurgitation (AR). However, it remains unclear whether its coaxiality performance is related to procedural complications. Aim: Our goal was to improve the efficacy and accuracy of TAVR in patients with AR by adjusting J-Valve coaxiality using three-dimensional printing (3DP). Methods: This multicenter, prospective study included 612 patients with AR who underwent transapical TAVR. Of these, 228 patients were assigned to the 3DP group, in which the insertion angle and implantation depth were pre-determined. The coaxiality index was calculated using the distances from the bottom of the bioprosthesis to the base of the three cusps. Results: Compared to the non-3DP group, the 3DP group demonstrated better coaxiality performance (coaxiality index: 3.4 ± 1.7 vs. 4.0 ± 2.1; coaxiality angle: 10.5 ± 3.7° vs. 12 ± 4.2°; both p<0.001). Post-operative coaxiality index showed a strong correlation with the coaxiality angle (correlation coefficients: 0.85 in the 3DP group and 0.88 in the non-3DP group). The procedural success rate was higher in the 3DP group (100% vs. 96.4%; p=0.008). Paravalvular leakage (PVL) occurred less frequently in the 3DP group (mild PVL: 3.51% vs. 18.2%; p<0.001; moderate PVL: 0% vs. 1.04%; p<0.001). Multivariable analysis identified the coaxiality index, coaxiality angle, and horizocardia as independent predictors of PVL. Conclusion: PVL incidence after TAVR can be reduced through pre-operative simulations that adjust coaxiality using 3DP. Relevance for patients: The high incidence of PVL in transapical TAVR with the J-Valve is associated with coaxiality after bioprosthesis implantation. This study suggests that adjusting coaxiality using pre-procedural 3DP simulations may effectively reduce PVL incidence and other procedural complications during transapical TAVR. In the future, randomized clinical trials will be needed to evaluate the efficacy and accuracy of pre-procedural 3DP simulations and the coaxiality index in treating patients with pure AR undergoing transapical TAVR.

Keywords
Aortic regurgitation
Transcatheter aortic valve replacement
Three-dimensional printing
Coaxiality
Clinical outcome
Funding
This work was supported by the Development and Transformation of New Technology and Construction of Precision Diagnosis and Treatment System for Transcatheter Interventional Diagnosis and Treatment of Structural Heart Diseases (2022YFC2503400); National Natural Science Foundation (82370375); Research on Key Techniques of Minimally Invasive Treatment for Valvular Heart Diseases (2023-YBSF-105); Xijing Hospital Booster Foundation (XJZT24LY42); and Safety and Efficacy of 3D Printing in Transcatheter Aortic Valve Replacement: A National Multicenter, Prospective Study Program (XJZT24LY42).
Conflict of interest
The authors declare they have no conflicts of interest.
References
  1. Aluru JS, Barsouk A, Saginala K, Rawla P, Barsouk A. Valvular heart disease epidemiology. Med Sci (Basel). 2022;10(2):32. doi: 10.3390/medsci10020032

 

  1. Maurer G. Aortic regurgitation. Heart. 2006;92:994-1000.

 

  1. Mack MJ, Leon MB, Thourani VH, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med. 2019;380(18):1695-1705. doi: 10.1056/NEJMoa1814052

 

  1. Popma JJ, Deeb GM, Yakubov SJ, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med. 2019;380(18):1706-1715. doi: 10.1056/NEJMoa1816885

 

  1. Roy D, Sharma R, Brecker SJ. Native aortic valve regurgitation: Transcatheter therapeutic options. EuroIntervention. 2013;9:S55-S62. doi: 10.4244/EIJV9SSA11

 

  1. Sawaya FJ, Deutsch MA, Seiffert M, et al. Safety and efficacy of transcatheter aortic valve replacement in the treatment of pure aortic regurgitation in native valves and failing surgical bioprostheses: Results from an international registry study. JACC Cardiovasc Interv. 2017;10(10):1048-1056. doi: 10.1016/j.jcin.2017.03.004

 

  1. Wei L, Liu H, Zhu L, et al. A new transcatheter aortic valve replacement system for predominant aortic regurgitation implantation of the J-valve and early outcome. JACC Cardiovasc Interv. 2015;8(14):1831-1841. doi: 10.1016/j.jcin.2015.08.021

 

  1. Athappan G, Patvardhan E, Tuzcu EM, et al. Incidence, predictors, and outcomes of aortic regurgitation after transcatheter aortic valve replacement: meta-analysis and systematic review of literature. J Am Coll Cardiol. 2013;61(15):1585-1595. doi: 10.1016/j.jacc.2013.01.047

 

  1. Shi J, Wei L, Chen Y, et al. Transcatheter aortic valve implantation with J-Valve: 2-year outcomes from the multicenter study. Ann Thorac Surg. 2021;111(5):1530-1536. doi: 10.1016/j.athoracsur.2020.06.139

 

  1. Liu L, Chen S, Shi J, Qin C, Guo Y. Transcatheter aortic valve replacement in aortic regurgitation. Ann Thorac Surg. 2020;110(6):1959-1965. doi: 10.1016/j.athoracsur.2020.03.112

 

  1. Abramowitz Y, Maeno Y, Chakravarty T, et al. Aortic angulation attenuates procedural success following self-expandable but not balloon-expandable TAVR. JACC Cardiovasc Imaging. 2016;9(8):964-972. doi: 10.1016/j.jcmg.2016.02.030. Epub 2016 Jul 13

 

  1. VARC-3 WRITING COMMITTEE, Généreux P, Piazza N, et al. Valve academic research consortium 3: Updated endpoint definitions for aortic valve clinical research. Eur Heart J. 2021;42(19):1825-1857. doi: 10.1093/eurheartj/ehaa799

 

  1. Pan W, Zhou D, Cheng L, Ge J. Aortic regurgitation is more prevalent than aortic stenosis in Chinese elderly population: Implications for transcatheter aortic valve replacement. Int J Cardiol. 2015;201:547-548. doi: 10.1016/j.ijcard.2014.10.069

 

  1. Otto CM, Nishimura RA, Bonow RO, et al. 2020 ACC/AHA guideline for the management of patients with valvular heart disease: A report of the American college of cardiology/ American heart association joint committee on clinical practice guidelines. Circulation. 2021;143(5):e72-e227. doi: 10.1161/CIR.0000000000000923

 

  1. Vahanian A, Beyersdorf F, Praz F, et al. 2021 ESC/EACTS guidelines for the management of valvular heart disease. Eur Heart J. 2022;43(7):561-632. doi: 10.1093/eurheartj/ehab395

 

  1. Marijon E, Mirabel M, Celermajer DS, Jouven X. Rheumatic heart disease. Lancet. 2012;379(9819):953-964. doi: 10.1016/S0140-6736(11)61171-9

 

  1. Frank MW, Mehlman DJ, Tsai F, Lomasney JW, Joob AW. Syphilitic aortitis. Circulation. 1999;100(14):1582-1583. doi: 10.1161/01.cir.100.14.1582

 

  1. Lu J, Lu Y, Wang X, et al. Prevalence, awareness, treatment, and control of hypertension in China: Data from 1.7 million adults in a population-based screening study (China PEACE million persons project). Lancet. 2017;390(10112):2549-2558. doi: 10.1016/S0140-6736(17)32478-9

 

  1. Bonow RO, Lakatos E, Maron BJ, Epstein SE. Serial long-term assessment of the natural history of asymptomatic patients with chronic aortic regurgitation and normal left ventricular systolic function. Circulation. 1991;84(4):1625-1635. doi: 10.1161/01.cir.84.4.1625

 

  1. Dujardin KS, Enriquez-Sarano M, Schaff HV, Bailey KR, Seward JB, Tajik AJ. Mortality and morbidity of aortic regurgitation in clinical practice. A long-term follow-up study. Circulation. 1999;99(14):1851-1857. doi: 10.1161/01.cir.99.14.1851

 

  1. Babaliaros V, Cribier A. The expansion of transcatheter technology to treat aortic insufficiency: Everything old becomes new again. JACC Cardiovasc Interv. 2014;7(10):1175-1176. doi: 10.1016/j.jcin.2014.07.005

 

  1. Rawasia WF, Khan MS, Usman MS, et al. Safety and efficacy of transcatheter aortic valve replacement for native aortic valve regurgitation: A systematic review and meta-analysis. Catheter Cardiovasc Interv. 2019;93(2):345-353. doi: 10.1002/ccd.27840

 

  1. Fitzgerald S, Dumpies O, Shibata M, et al. Femoral arterial calcification and plug- vs. Suture-based closure device strategies post-transcatheter aortic valve implantation: Insights from CHOICE-CLOSURE. Struct Heart. 2023;8(2):100236. doi: 10.1016/j.shj.2023.100236

 

  1. Yoon SH, Schmidt T, Bleiziffer S, et al. Transcatheter aortic valve replacement in pure native aortic valve regurgitation. J Am Coll Cardiol. 2017;70(22):2752-2763. doi: 10.1016/j.jacc.2017.10.006

 

  1. Genereux P, Head SJ, Hahn R, et al. Paravalvular leak after transcatheter aortic valve replacement: The new Achilles’ heel? A comprehensive review of the literature. J Am Coll Cardiol. 2013;61(11):1125-1136. doi: 10.1016/j.jacc.2012.08.1039

 

  1. Moat NE, Ludman P, De Belder MA, et al. Long-term outcomes after transcatheter aortic valve implantation in high-risk patients with severe aortic stenosis: The U.K. TAVI (United Kingdom transcatheter aortic valve implantation) registry. J Am Coll Cardiol. 2011;58(20):2130-2138. doi: 10.1016/j.jacc.2011.08.050

 

  1. Claessen BE, Tang GHL, Kini AS, Sharma SK. Considerations for optimal device selection in transcatheter aortic valve replacement: A review. JAMA Cardiol. 2021;6(1):102-112. doi: 10.1001/jamacardio.2020.3682

 

  1. Silaschi M, Conradi L, Wendler O, et al. The JUPITER registry: One-year outcomes of transapical aortic valve implantation using a second generation transcatheter heart valve for aortic regurgitation. Catheter Cardiovasc Interv. 2018;91(7):1345-1351. doi: 10.1002/ccd.27370

 

  1. Markham R, Ghodsian M, Sharma R. TAVR in patients with pure aortic regurgitation: Ready to use? Curr Cardiol Rep. 2020;22(9):98. doi: 10.1007/s11886-020-01338-6

 

  1. Medranda GA, Musallam A, Zhang C, et al. The impact of aortic angulation on contemporary transcatheter aortic valve replacement outcomes. JACC Cardiovasc Interv. 2021;14(11):1209-1215. doi: 10.1016/j.jcin.2021.03.027

 

  1. Wang DD, Qian Z, Vukicevic M, et al. 3D printing, computational modeling, and artificial intelligence for structural heart disease. JACC Cardiovasc Imaging. 2021;14(1):41-60. doi: 10.1016/j.jcmg.2019.12.022

 

  1. Alkhouli M, Sengupta PP. 3-Dimensional-printed models for TAVR planning: Why guess when you can see? JACC Cardiovasc Imaging. 2017;10(7):732-734. doi: 10.1016/j.jcmg.2017.05.002

 

Next article in this issue
Share
Back to top
Journal of Clinical and Translational Research, Electronic ISSN: 2424-810X Print ISSN: 2382-6533, Published by AccScience Publishing
We use cookies on our website to ensure you get the best experience.
Read more about our cookies here
Accept