title: Development of an algorithm to plan and simulate a new interventional procedure.
abstract: OBJECTIVE
  The number of implanted biological valves for treatment of valvular heart disease is growing and a percentage of these patients will eventually undergo a transcatheter valve-in-valve (ViV) procedure. Some of these patients will represent challenging cases. The aim of this study was to develop a feasible algorithm to plan and in vitro simulate a new interventional procedure to improve patient outcome.
  
  
  METHODS
  In addition to standard diagnostic routine, our algorithm includes 3D printing of the annulus, hydrodynamic measurements and high-speed analysis of leaflet kinematics after simulation of the procedure in different prosthesis positions as well as X-ray imaging of the most suitable valve position to create a 'blueprint' for the patient procedure.
  
  
  RESULTS
  This algorithm was developed for a patient with a degenerated Perceval aortic sutureless prosthesis requiring a ViV procedure. Different ViV procedures were assessed in the algorithm and based on these results the best option for the patient was chosen. The actual procedure went exactly as planned with help of this algorithm.
  
  
  CONCLUSIONS
  Here we have developed a new technically feasible algorithm simulating important aspects of a novel interventional procedure prior to the actual procedure. This algorithm can be applied to virtually all patients requiring a novel interventional procedure to help identify risks and find optimal parameters for prosthesis selection and placement in order to maximize safety for the patient.
authors.affiliation: Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany bfujita@hdz-nrw.de.
authors.forename: Buntaro
authors.initials: B
authors.lastname: Fujita
authors.affiliation: Institute of Applied Medical Engineering, Helmholtz-Institute, RWTH Aachen University, Aachen, Germany.
authors.forename: Maximilian
authors.initials: M
authors.lastname: Kütting
authors.affiliation: Department for Cardiology, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Smita
authors.initials: S
authors.lastname: Scholtz
authors.affiliation: Institute of Applied Medical Engineering, Helmholtz-Institute, RWTH Aachen University, Aachen, Germany.
authors.forename: Marc
authors.initials: M
authors.lastname: Utzenrath
authors.affiliation: Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Kavous
authors.initials: K
authors.lastname: Hakim-Meibodi
authors.affiliation: Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Lech
authors.initials: L
authors.lastname: Paluszkiewicz
authors.affiliation: Institute of Applied Medical Engineering, Helmholtz-Institute, RWTH Aachen University, Aachen, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Schmitz
authors.affiliation: Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Jochen
authors.initials: J
authors.lastname: Börgermann
authors.affiliation: Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Jan
authors.initials: J
authors.lastname: Gummert
authors.affiliation: Institute of Applied Medical Engineering, Helmholtz-Institute, RWTH Aachen University, Aachen, Germany.
authors.forename: Ulrich
authors.initials: U
authors.lastname: Steinseifer
authors.affiliation: Department for Thoracic and Cardiovascular Surgery, Heart and Diabetes Center NRW, Ruhr-University Bochum, Bad Oeynhausen, Germany.
authors.forename: Stephan
authors.initials: S
authors.lastname: Ensminger
mesh_terms: D000368:Aged; D000465:Algorithms; D001021:Aortic Valve / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000175:diagnosis / Q000503:physiopathology / Q000601:surgery / Q000628:therapy*; D001696:Biomechanical Phenomena; D006328:Cardiac Catheterization / Q000295:instrumentation / Q000379:methods*; D018618:Echocardiography, Doppler, Color; D005240:Feasibility Studies; D005260:Female; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000295:instrumentation / Q000379:methods*; D006439:Hemodynamics; D006801:Humans; D008953:Models, Anatomic; D008955:Models, Cardiovascular; D061330:Multidetector Computed Tomography; D011237:Predictive Value of Tests; D066330:Printing, Three-Dimensional; D011474:Prosthesis Design; D011475:Prosthesis Failure; D011857:Radiographic Image Interpretation, Computer-Assisted; D013813:Therapy, Computer-Assisted / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome
keywords: Safety; Simulation; Transcatheter aortic valve implantation; Valve-in-valve