3D打印主动脉根部模型在经导管主动脉瓣置换术前评估中的应用OA

Objective To construct 3D-printed models of the aortic root based on contrast-enhanced CT angiography(CTA)data and to explore their application value in the preoperative evaluation of transcatheter aortic valve replacement(TAVR).Methods Twenty-one patients with aortic valve disease were enrolled from Linfen People's Hospital.All patients underwent CTA of the aorta and coronary arteries.The aortic root was reconstructed using Mimics medical imaging software and subsequently printed into 3D models.Parameters including the aortic annulus maximum and minimum diameters of junction of the aortic sinus and the sinus canal,as well as the aortic valve area and perimeter,and the distance from the coronary ostia to the annulus,were measured on both the CTA images and the 3D-printed models.Statistical analysis was performed to compare the two sets of measurements.The parameters of the aortic annulus and coronary ostia were measured and the calcification and vascular access conditions were evaluated on the 3D-printed model,and preoperative planning was carried out based on the above evaluation results to avoid surgical risks.Echocardiographic and electrocardiographic data before and after surgery were compared.Results There were no statistically significant differences in terms of the diameter of the aortic annulus,the aortic valve area and perimeter,the distance from the coronary ostia to the annulus,or the diameter of junction of the aortic sinus and the sinus canal between CTA and 3D-printed models(P>0.05).Among the 21 patients,18 cases underwent TAVR alone,while 3 cases received TAVR combined with coronary intervention.Based on the 3D-printed models,high risk of coronary obstruction was predicted in 5 cases,and protective measures were successfully implemented during surgery,with no coronary obstruction occurring.The agreement rate between the valve size preselected using the 3D-printed models and the size actually implanted was 90.5%(19/21),no perivalvular leakage occurred during the perioperative period.There were significant differences in the transvalvular pressure gradient,left ventricular ejection fraction(LVEF),left ventricular end-diastolic diameter,and the proportion of patients with NYHA cardiac function classification Ⅳ 3 months,6 months,12 months after surgery compared with those before surgery(P<0.05).Conclusion 3D-printed model of the aortic root constructed based on CTA can accurately replicate aortic root anatomy.Preoperative planning utilizing these models can effectively reduce the risk of intraoperative coronary obstruction and the incidence of postoperative paravalvular leakage.