Aortic root sizing for transcatheter aortic valve implantation using a shape model parameterisation


During a transcatheter aortic valve implantation, an axisymmetric implant is placed in an irregularly shaped aortic root. Implanting an incorrect size can cause complications such as leakage of blood alongside or through the implant. The aim of this study was to construct a method that determines the optimal size of the implant based on the three-dimensional shape of the aortic root. Based on the pre-interventional computed tomography scan of 89 patients, a statistical shape model of their aortic root was constructed. The weights associated with the principal components and the volume of calcification in the aortic valve were used as parameters in a classification algorithm. The classification algorithm was trained using the patients with no or mild leakage after their intervention. Subsequently, the algorithms were applied to the patients with moderate to severe leakage. Cross validation showed that a random forest classifier assigned the same size in 65 ± 7% of the training cases, while 57 ± 8% of the patients with moderate to severe leakage were assigned a different size. This initial study showed that this semi-automatic method has the potential to correctly assign an implant size. Further research is required to assess whether the different size implants would improve the outcome of those patients.

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This work was supported in part by a PhD grant (120198) from the agency for innovation through science and technology (IWT) of the Flemish government.

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Correspondence to Bart Bosmans or Toon Huysmans.

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Conflict of interest

Prof. Dr. Johan Bosmans and Prof. Dr. Peter de Jaegere are part-time clinical proctor for Medtronic. Prof. Dr. ir. Jos Vander Sloten is a member of the Board of Directors of Materialise N.V. and a shareholder. The remaining authors have no conflicts of interest to declare.

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Bosmans, B., Huysmans, T., Lopes, P. et al. Aortic root sizing for transcatheter aortic valve implantation using a shape model parameterisation. Med Biol Eng Comput 57, 2081–2092 (2019).

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  • Statistical shape modelling
  • Aortic root sizing
  • Transcatheter aortic valve implantation