Enhancing TTVR Positioning: A Computational Framework for Pre-procedural Planning and Optimization

  • Mata Quiñonez, Luis René (Georgia Institute of Technology/Emory Univers)
  • Yadav, Pradeep (Piedmont Atlanta Hospital)
  • Dasi, Lakshmi (Georgia Institute of Technology/Emory Univers)

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Background: Tricuspid regurgitation (TR) affects between 5 to 20% of adults in the USA1. Transcatheter replacement (TTVR) using the Evoque system is a promising treatment, yet challenging due to complex requirements for depth, centricity, and leaflet capture1-2. We established a computational framework to address these challenges through predictive planning of optimal valve positioning. Methods & Results (Fig. 1): We developed a patient-specific Particle Swarm Optimization (PSO)-based tool intended to generate the best-suited valve position. This algorithm identifies ideal device coordinates (x,y,z) and tilt by maximizing anchor-leaflet interaction points while strictly avoiding the subvalvular apparatus. In a clinical case study, the optimized trajectory yielded superior positioning compared to standard geometric centering, ensuring engagement of all heterogeneous leaflets. We validated this strategy through focused Finite Element Analysis (FEA) of the capturing process, which demonstrated that the optimized position achieved maximal anchor-leaflet adhesion compared to non-optimized scenarios (centered and intra-annular), while minimizing the risk of device entrapment. Conclusion: This study highlights the distinct value of optimization algorithms for improving device position and ensuring effective leaflet capture in TTVR. The planning tool offers superior prospective positioning strategies over geometric defaults. Future work will integrate detailed subvalvular models to enhance the simulation’s predictive fidelity and validate the framework through a larger multi-patient cohort.