Compliant aortic annulus sizing with different elliptical ratios through a valvuloplasty balloon catheter

Journal article

Objective: Aortic stenos (AS) is a heart valve disease that commonly affects the elderly. Transcatheter aortic valve implantation is a minimally invasive treatment that allows to replace the function of the diseased native valve with a prosthetic device, relying on catheters for device implantation. According to the current clinical guidelines, the choice of the implanted device is based on preoperative sizing determined by image-based technology. However, this assessment faces inherent limitations that can lead to sub-optimal sizing of the prosthesis; in turn, this can cause major post-operative complications like aortic regurgitation or cardiac electrical signal disruption.

Method: By utilizing balloon pressure and volume data, this article proposes an intra-operative method for determining the dimension of the aortic annulus which takes into account its compliance and geometric irregularity. The intra-balloon pressure-volume curves were obtained using an Automated Balloon Inflation Device operating a commercially available valvuloplasty balloon catheter. A sizing algorithm to estimate the dimensions of the annulus was integrated via a validated analytical model and a numerical model for balloon free-inflation. Tests were performed on circular and elliptical idealised aortic phantoms.

Results: Experimental results confirm that the pressure-volume data processed with the sizing algorithm can be used to determine the circular annular diameter for all tissue rigidities.

Conclusion: The measurement of stiffer elliptical annulus phantoms shows good accuracy and high repeatability. Significance: This work represents substantial progress toward improving the selection of TAVI devices by using balloon catheters to improve the sizing of compliant aortic annuli with complex geometry

Authors: Yao, J; Bosi, GM; Palombi, A; Burriesci, G; Wurdemann, H

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: IEEE
• Journal: IEEE Transactions on Biomedical Engineering
• Volume: 70
• Issue: 12
• Pages: 3469-3479
• Publication date: 2023-06-26
• Acceptance date: 2023-06-13
• DOI: 10.1109/tbme.2023.3289300
• EISSN: 1558-2531
• ISSN: 0018-9294
• Language: English
• Keywords: balloon; aortic valvuloplasty; sizing; catheter; annulus (botany); balloon valvuloplasty; balloon catheter; biomedical engineering; medicine; cardiology; materials science; aortic valve; radiology; aortic valve stenosis