Vlad Ciobotaru: Structural and Valvular Unit, Hôpital Privé les Franciscaines, 7 Rue Jean Bouin, 30000 Nîmes, France.
Victor-Xavier Tadros: Structural and Valvular Unit, Hôpital Privé les Franciscaines, 7 Rue Jean Bouin, 30000 Nîmes, France. ORCID
Marcos Batistella: IMT, Mines Telecom Institute, 30319 Ales, France.
Eric Maupas: Structural and Valvular Unit, Hôpital Privé les Franciscaines, 7 Rue Jean Bouin, 30000 Nîmes, France.
Romain Gallet: Cardiology Unit, Hôpital Henri Mondor (AP-HP), 51 Avenue du Maréchal de Lattre de Tassigny, 94010 Créteil, France.
Benoit Decante: Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Inserm UMR-S 999, BME Lab, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France. ORCID
Emmanuel Lebret: Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Inserm UMR-S 999, BME Lab, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France.
Benoit Gerardin: Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Inserm UMR-S 999, BME Lab, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France.
Sebastien Hascoet: Hôpital Marie Lannelongue, Groupe Hospitalier Paris Saint Joseph, Faculté de Médecine Paris-Saclay, Université Paris-Saclay, Inserm UMR-S 999, BME Lab, 133 Avenue de la Résistance, 92350 Le Plessis Robinson, France. ORCID
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.
