Transcatheter Aortic Root Replacement (tarr). A Preliminary Study
Enrico Ferrari1, Piergiorgio Tozzi2, Denis Berdajs3, Francesco Maisano4, Ludwig von Segesser2.
1Cardiocentro Ticino, Lugano, Switzerland, 2CHUV, Lausanne, Switzerland, 3Ubiversity of Basel, Basel, Switzerland, 4University of Zurich, Zurich, Switzerland.
OBJECTIVE: TAVR is widely used in elderly patients with aortic stenosis. However, 25% of patients with aortic valve stenosis also have dilated aortic roots that are not addressed with standard TAVR. Therefore, a new technology is required: the concept of the TARR technique combines aortic valve replacement and aortic root replacement in a single-stage transcatheter procedure. We present a preliminary bench test.
METHODS: 3D-printed aortic roots based on pre-operative CT-scans from patients with aortic valve disease and root dilatation were prepared. Hydrodynamic tests were performed on 3D printed models with original configuration. Then, a new device integrating a trans-catheter valve, an aortic endoprosthesis and two conduits for coronary perfusion was assembled. The device was deployed inside the 3D-printed aortic root and hydrodynamic tests were performed.
RESULTS: mean non-pulsatile coronary flows for the standard root at 60, 80 and 100 mmHg were 1066, 1307, 1460 mL/min. for the left coronary and 1460, 2330, 2330 mL/min for the right coronary. Mean coronary flows for the root with the deployed TARR device at 60, 80 and 100 mmHg were 1053, 1306, 1502 mL/min for the left coronary artery and 1100, 1460, 1620mL/min for the right coronary artery.
CONCLUSIONS: this preliminary report shows that the concept behind the TARR technique guarantees an adeguate coronary flow in 3D-printed aortic roots. Further hydrodynamic tests are required before TARR in animals.