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Sadat N, Scharfschwerdt M, Reichert S, Fujita B, Ensminger S. Impact of Different Valve-in-Valve Positions on Functional Results of the New Generation of Balloon-Expandable Transcatheter Heart Valve. Thorac Cardiovasc Surg 2024. [PMID: 38889748 DOI: 10.1055/s-0044-1787701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/20/2024]
Abstract
OBJECTIVES Very precise positioning of the transcatheter heart valve (THV) inside the degenerated SAV is a crucial factor for valve-in-valve (ViV) procedure to achieve optimal hemodynamic results. Therefore, our study aimed to investigate the impact of implantation depth on functional results after ViV procedures in a standardized in vitro setting. METHODS THV (SAPIEN 3 Ultra 23-mm size) and three SAV models (Magna Ease, Trifecta, and Hancock II-all 21-mm size) were tested at different circulatory conditions in five different positions of the THV (2-6 mm) inside the SAV. Mean pressure gradient (MPG), effective orifice area (EOA), geometric orifice area (GOAmax), and pinwheeling index (PWImean) were analyzed. RESULTS EOA and MPG of the THV did not differ significantly regarding the position inside the Magna Ease and the Hancock II (p > 0.05). However, EOA differed significantly, depending on the position of the THV inside Trifecta (2 vs. 5 mm; p = 0.021 and 2 vs. 6 mm; p < 0.001). The THV presented the highest EOA (2.047 cm2) and the lowest MPG (5.387 mm Hg) inside the Magna Ease, whereas the lowest EOA (1.335 cm2) and the highest MPG (11.876 mm Hg) were shown inside the Hancock II. Additionally, the highest GOAmax and the lowest PWImean of the THV were noticed inside the Magna Ease. The THV showed lower GOAmax and higher PWImean inside the Trifecta when placed in a deeper position. CONCLUSION Deep implantation of the SAPIEN 3 Ultra inside the Trifecta correlates with impaired functional results. In contrast, the implantation position of the SAPIEN 3 Ultra inside the Magna Ease and the Hancock II did not have a significant effect on functional results.
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Affiliation(s)
- Najla Sadat
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Schleswig-Holstein, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Schleswig-Holstein, Germany
| | - Stefan Reichert
- Department of Cardio-Thoracic and Vascular Surgery, University Hospital Tübingen, Tübingen, Baden-Württemberg, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Schleswig-Holstein, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig Holstein Lübeck Campus, Lübeck, Schleswig-Holstein, Germany
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2
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Fukui M, Cavalcante JL, Bapat VN. Deformation in transcatheter heart valves: Clinical implications and considerations. J Cardiol 2024; 83:351-358. [PMID: 38432474 DOI: 10.1016/j.jjcc.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 02/19/2024] [Accepted: 02/26/2024] [Indexed: 03/05/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as a preferred treatment modality for aortic stenosis, marking a significant advancement in cardiac interventions. Transcatheter heart valves (THVs) have also received approval for treating failed bioprosthetic valves and rings across aortic, mitral, tricuspid, and pulmonic positions. Unlike surgically implanted valves, which are sewn into the annulus, THVs are anchored through relative oversizing. Although THVs are designed to function optimally in a fully expanded state, they exhibit a certain degree of tolerance to underexpansion. However, significant deformation beyond this tolerance can adversely affect the valve's hemodynamics and durability, ultimately impacting patient outcomes. Such post-implantation deviations from the valve's intended three-dimensional design are influenced by a variety of physiological and anatomical factors unique to each patient and procedure, leading to underexpansion, eccentric expansion, and vertical deformation. These deformation patterns increase leaflet stress and strain, potentially causing fatigue and damage. This review article delves into the extent of THV deformation, its impact on leaflet function, hypoattenuating leaflet thickening, and structural valve degeneration. It provides an in-depth analysis of deformation specifics in different procedural contexts, including TAVR in native aortic stenosis, aortic and mitral valve-in-valve procedures, and redo-TAVR. Additionally, the review discusses strategies to mitigate THV deformation during the procedure, offering insights into potential solutions to these challenges.
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Affiliation(s)
- Miho Fukui
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA.
| | - João L Cavalcante
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Vinayak N Bapat
- Minneapolis Heart Institute Foundation, Minneapolis, MN, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
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Nasir MM, Ikram A, Usman M, Sarwar J, Ahmed J, Hamza M, Farhan SA, Siddiqi R, Qadar LT, Shah SR, Khalid MR, Memon RS, Hameed I. Valve-in-Valve Transcatheter Aortic Valve Replacement Versus Redo-Surgical Aortic Valve Replacement in Patients With Aortic Stenosis: A Systematic Review and Meta-analysis. Am J Cardiol 2024; 225:151-159. [PMID: 38723857 DOI: 10.1016/j.amjcard.2024.04.057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/11/2024] [Revised: 04/22/2024] [Accepted: 04/26/2024] [Indexed: 05/21/2024]
Abstract
Aortic stenosis is a common and significant valve condition requiring bioprosthetic heart valves with transcatheter aortic valve replacement (TAVR) being strongly recommended for high-risk patients or patients over 75 years. This meta-analysis aimed to pool existing data on postprocedural clinical as well as echocardiographic outcomes comparing valve-in-valve (ViV)-TAVR to redo-surgical aortic valve replacement to assess the short-term and medium-term outcomes for both treatment methods. A systematic literature search on Cochrane Central, Scopus, and Medline (PubMed interface) electronic databases from inception to August 2023. We used odds ratios (OR) for dichotomous outcomes and mean differences (MD) for continuous outcomes. Twenty-four studies (25,216 patients) were pooled with a mean follow-up of 16.4 months. The analysis revealed that ViV-TAVR group showed a significant reduction in 30-day mortality (OR 0.50, 95% confidence interval [CI] 0.43 to 0.58, p <0.00001), new-onset atrial fibrillation (OR 0.34, 95% CI 0.17 to 0.67, p = 0.002), major bleeding event (OR 0.28, 95% CI 0.17 to 0.45, p <0.00001) and lower rate of device success (OR 0.25, 95% CI 0.12 to 0.53, p = 0.0003). There were no significant differences between either group when assessing 1-year mortality, stroke, myocardial infarction, postoperative left ventricular ejection fraction, and effective orifice area. ViV-TAVR cohort showed a significantly increased incidence of paravalvular leaks, aortic regurgitation, and increased mean aortic valve gradient. ViV-TAVR is a viable short-term option for older patients with high co-morbidities and operative risks, reducing perioperative complications and improving 30-day mortality with no significant cardiovascular adverse events. However, both treatment methods present similar results on short-term to medium-term complications assessment.
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Affiliation(s)
- Muhammad Moiz Nasir
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan.
| | - Armeen Ikram
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Muhammad Usman
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Jawad Sarwar
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Jawad Ahmed
- Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan
| | - Mohammad Hamza
- Department of Internal Medicine, Guthrie Medical Group, Cortland, New York
| | - Syed Ali Farhan
- Department of Surgery, Ohio State University, Columbus, Ohio
| | - Rabbia Siddiqi
- Department of Internal Medicine, University of Toledo, Ohio
| | - Laila Tul Qadar
- Department of Internal Medicine, St Vincent's Medical Center, Bridgeport, Connecticut
| | - Syed Raza Shah
- Division of Cardiovascular Medicine, University of Louisville, Louisville, Kentucky
| | | | - Roha Saeed Memon
- Department of Internal Medicine, Jacobi Medical Center-New York City Health + Hospitals Corporation/Albert Einstein College of Medicine, Bronx, New York
| | - Irbaz Hameed
- Division of Cardiac Surgery, Yale University School of Medicine, New Haven, Connecticut
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4
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Meier D, Grant D, Frawley C, Akodad M, Landes U, Khokhar AA, Dudek D, George I, Rinaldi MJ, Kim WK, Yakubov SJ, Sorajja P, Tarantini G, Wood DA, Webb JG, Sellers SL, Sathananthan J. Redo-TAVI with the ACURATE neo2 and Prime XL for balloon-expandable transcatheter heart valve failure. EUROINTERVENTION 2024; 20:e376-e388. [PMID: 38506739 PMCID: PMC10941669 DOI: 10.4244/eij-d-23-00783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/16/2023] [Accepted: 11/06/2023] [Indexed: 03/21/2024]
Abstract
BACKGROUND There are limited data regarding treatment for failed balloon-expandable transcatheter heart valves (THVs) in redo-transcatheter aortic valve implantation (TAVI). AIMS We aimed to assess THV performance, neoskirt height and expansion when performing redo-TAVI with the ACURATE platform inside a SAPIEN 3 (S3) compared to redo-TAVI with an S3 in an S3. METHODS Redo-TAVI was performed on the bench using each available size of the S3, the ACURATE neo2 (ACn2) and the next-generation ACURATE Prime XL (AC XL) implanted at 2 different depths within 20 mm/23 mm/26 mm/29 mm S3s serving as the "failed" index THV. Hydrodynamic testing was performed to assess THV function. Multimodality assessment was performed using photography, X-ray, microcomputed tomography (micro-CT), and high-speed videos. RESULTS The ACURATE in S3 combinations had favourable hydrodynamic performance compared to the S3 in S3 for all size combinations. In the 20 mm S3, redo-TAVI with the ACn2 had lower gradients compared to the S3 (mean gradient 16.3 mmHg for the ACn2 vs 24.7 mmHg for the 20 mm S3 in 20 mm S3). Pinwheeling was less marked for the ACURATE THVs than for the S3s. On micro-CT, the S3s used for redo-TAVI were underexpanded across all sizes. This was also observed for the ACURATE platform, but to a lesser extent. CONCLUSIONS Redo-TAVI with an ACn2/AC XL within an S3 has favourable hydrodynamic performance and less pinwheeling compared to an S3 in S3. This comes at the price of a taller neoskirt.
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Affiliation(s)
- David Meier
- Department of Cardiology, Lausanne University Hospital and University of Lausanne, Lausanne, Switzerland
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
| | - Daire Grant
- Boston Scientific Corporation, Marlborough, MA, USA
| | | | - Mariama Akodad
- Ramsay Santé, Institut Cardiovasculaire Paris Sud, Hôpital Privé Jacques Cartier, Massy, France
| | - Uri Landes
- Edith Wolfson Medical Center, Holon, Israel and Tel-Aviv University, Tel-Aviv, Israel
| | - Arif A Khokhar
- Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom
| | - Dariusz Dudek
- Jagiellonian University Medical College, Krakow, Poland
- Maria Cecilia Hospital, GVM Care & Research, Cotignola, Italy
| | - Isaac George
- Division of Cardiothoracic Surgery, Columbia University Medical Center, NewYork-Presbyterian Hospital, New York, NY, USA
| | | | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Klinik Heart Center, Bad Nauheim, Germany
| | - Steven J Yakubov
- Department of Interventional Cardiology, Riverside Methodist-OhioHealth Hospital, Columbus, OH, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA and Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Giuseppe Tarantini
- Humanitas Research Hospital IRCCS, Rozzano, Italy
- University of Padua Medical School, Padua, Italy
| | - David A Wood
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - John G Webb
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Stephanie L Sellers
- Cardiovascular Translational Laboratory, Providence Research & Centre for Heart Lung Innovation, Vancouver, BC, Canada
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Boston Scientific Corporation, Marlborough, MA, USA
- Centre for Cardiovascular Innovation, St Paul's and Vancouver General Hospital, Vancouver, BC, Canada
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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5
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Fukui M, Okada A, Burns MR, Sato H, Thao KR, Wang C, Koike H, Hamid N, Enriquez-Sarano M, Lesser JR, Cavalcante JL, Sorajja P, Bapat VN. Deformation of transcatheter heart valves with mitral valve-in-valve. EUROINTERVENTION 2023; 19:e937-e947. [PMID: 37899719 PMCID: PMC10719737 DOI: 10.4244/eij-d-23-00614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2023] [Accepted: 09/24/2023] [Indexed: 10/31/2023]
Abstract
BACKGROUND The use of oversizing in mitral valve-in-valve (MViV) procedures can lead to non-uniform expansion of transcatheter heart valves (THV). This may have implications for THV durability. AIMS The objective of this study was to assess the extent and predictors of THV deformation in MViV procedures. METHODS We examined 33 patients who underwent MViV with SAPIEN prostheses. The extent of THV deformation (deformation index, eccentricity, neosinus volume, asymmetric leaflet expansion and vertical deformation) and hypoattenuating leaflet thickening (HALT) were assessed using cardiac computed tomography (CT), performed prospectively at 30 days post-procedure. For descriptive purposes, the THV deformation index was calculated, with values >1.00 representing a more hourglass shape. RESULTS Non-uniform underexpansion of THV was common after MViV implantation, with a median expansion area of 74.0% (interquartile range 68.1-84.1) at the narrowest level and a THV deformation index of 1.21 (1.13-1.29), but circularity was maintained with eccentricity ranging from 0.24 to 0.28. The degree of oversizing was a key factor associated with greater underexpansion and a higher deformation index (β=-0.634; p<0.001; β=0.594; p<0.001, respectively). Overall, the incidence of HALT on the 30-day postprocedural CT was 27.3% (9 of 33). Most patients (32 of 33) were on anticoagulation therapy, but the prothrombin time and international normalised ratio (PT-INR) at the time of the CT scan was <2.5 in 23 of 32 patients. Among patients with a PT-INR of <2.5, HALT was predominantly observed with a high THV deformation index of ≥1.18. CONCLUSIONS THV deformation, i.e., underexpansion and an hourglass shape, commonly occurs after MViV implantation and is negatively affected by excessive oversizing. Optimising THV expansion during MViV could potentially prevent HALT.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Atsushi Okada
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Marcus R Burns
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Hirotomo Sato
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Kiahltone R Thao
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Cheng Wang
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Hideki Koike
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
| | - Nadira Hamid
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | | | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Joao L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, MN, USA
- Allina Health Minneapolis Heart Institute - Minneapolis, Abbott Northwestern Hospital, Minneapolis, MN, USA
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6
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Xiao Z, Yao J, Liu X, Yuan F, Yan Y, Luo T, Wang M, Zhang H, Ren F, Song G. Determinants of device success after transcatheter aortic valve replacement in patients with type-0 bicuspid aortic stenosis. Front Cardiovasc Med 2023; 10:1279687. [PMID: 38028471 PMCID: PMC10657190 DOI: 10.3389/fcvm.2023.1279687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/23/2023] [Indexed: 12/01/2023] Open
Abstract
Background Clinical evidence of transcatheter aortic valve replacement in patients with type-0 bicuspid aortic valve was relatively scarce. Aims Our goal was to explore determinants of device success after transcatheter aortic valve replacement in patients with type-0 bicuspid aortic valve morphology. Methods In this retrospective multicenter analysis, we included 59 patients with symptomatic severe aortic stenosis with type-0 bicuspid aortic valve morphology who underwent transcatheter aortic valve replacement. Type-0 bicuspid aortic valve was identified with multidetector computed tomography scans. The technical success rate was 89.8%, and the device success rate was 81.4%. Patients were divided into a device success group and a device failure group according to Valve Academic Research Consortium- 3 criteria. Results When we compared the two groups, we found that the ellipticity index of the aortic root and the presence of bulky calcifications at the commissure were statistically different (ellipticity index 35.7 ± 1.7 vs. 29.7 ± 1.1, p = 0.018; bulky calcification at the commissure, 54.5% vs. 4.5%, p < 0.001). Further multivariate logistic analysis showed that bulky calcification at the commissure had a negative correlation with device success (odds ratio 0.030, 95% confidence interval 0.003-0.285, p = 0.002). Yet there was no statistical correlation between the ellipticity index and device success (odds ratio 0.818, 95% confidence interval 0.667-1.003, p = 0.053). Conclusions The presence of bulky calcifications at the commissure is negatively correlated with device success after transcatheter aortic valve replacement in patients with type-0 bicuspid aortic valve.
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Affiliation(s)
- Zhicheng Xiao
- Department of Cardiology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Jing Yao
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Xinmin Liu
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fei Yuan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Yunfeng Yan
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Taiyang Luo
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Moyang Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hongliang Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Faxin Ren
- Department of Cardiology, Qindao University Medical College Affiliated Yantai Yuhuangding Hospital, Yantai, China
| | - Guangyuan Song
- Interventional Center of Valvular Heart Disease, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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7
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Leone PP, Regazzoli D, Pagnesi M, Costa G, Teles R, Adamo M, Taramasso M, De Marco F, Mangieri A, Kargoli F, Ohno Y, Saia F, Ielasi A, Ribichini F, Maffeo D, Kim WK, Maisano F, Van Mieghem NM, Colombo A, Reimers B, Latib A. Prosthesis-patient mismatch after transcatheter implantation of contemporary balloon-expandable and self-expandable valves in small aortic annuli. Catheter Cardiovasc Interv 2023; 102:931-943. [PMID: 37668097 DOI: 10.1002/ccd.30818] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 07/29/2023] [Accepted: 08/19/2023] [Indexed: 09/06/2023]
Abstract
BACKGROUND Evidence of clinical impact of PPM after TAVI is conflicting and might vary according to the type of valve implanted. AIMS To assess the clinical impact of prosthesis-patient mismatch (PPM) after transcatheter aortic valve implantation (TAVI) with balloon-expandable (BEV) and self-expandable valves (SEV) in patients with small annuli. METHODS TAVI-SMALL 2 enrolled 628 patients in an international retrospective registry, which included patients with severe aortic stenosis and small annuli (annular perimeter <72 mm or area <400 mm2 ) treated with transfemoral TAVI at 16 high-volume centers between 2011 and 2020. Analyses were performed comparing patients with less than moderate (n = 452), moderate (n = 138), and severe PPM (n = 38). Primary endpoint was incidence of all-cause mortality. Predictors of all-cause mortality and PPM were investigated. RESULTS At a median follow-up of 380 days (interquartile range: 210-709 days), patients with severe PPM, but not moderate PPM, had an increased risk of all-cause mortality when compared with less than moderate PPM (log-rank p = 0.046). Severe PPM predicted all-cause mortality in patients with BEV (hazard ratio [HR]: 5.20, 95% confidence interval [CI]: 1.27-21.2) and intra-annular valves (IAVs, HR: 4.23, 95% CI: 1.28-14.02), and it did so with borderline significance in the overall population (HR: 2.89, 95% CI: 0.95-8.79). Supra-annular valve (SAV) implantation was the only predictor of severe PPM (odds ratio: 0.33, 95% CI: 0.13-0.83). CONCLUSIONS Patients with small aortic annuli and severe PPM after TAVI have an increased risk of all-cause mortality at early term follow-up, especially after IAV or BEV implantation. TAVI with SAV protected from severe PPM.
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Affiliation(s)
- Pier Pasquale Leone
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Damiano Regazzoli
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Matteo Pagnesi
- Department of Medical and Surgical specialties, Radiological Sciences and Public Health, Institute of Cardiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Giuliano Costa
- U.O.C. Cardiologia, Centro Alte Specialità e Trapianti, A.O.U. Policlinico "G. Rodolico-San Marco", Catania, Italy
| | - Rui Teles
- Hospital de Santa Cruz, Centro Hospitalar de Lisboa Ocidental, Nova Medical School, CEDOC, Lisbon, Portugal
| | - Marianna Adamo
- Department of Medical and Surgical specialties, Radiological Sciences and Public Health, Institute of Cardiology, ASST Spedali Civili, University of Brescia, Brescia, Italy
| | - Maurizio Taramasso
- HerzZentrum Hirslanden Zurich, University of Zurich, Zurich, Switzerland
| | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Milan, Italy
| | | | - Faraj Kargoli
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
| | - Yohei Ohno
- Department of Cardiology, Tokai University Hospital, Kanagawa, Japan
| | - Francesco Saia
- Cardiology Unit, St. Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Alfonso Ielasi
- Clinical and Interventional Unit, Sant'Ambrogio Cardio-Thoracic Center, Milan, Italy
| | - Flavio Ribichini
- Department of Medicine, Division of Cardiology, University of Verona, Verona, Italy
| | - Diego Maffeo
- Cardiovascular Department, Interventional Cardiology Unit, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy
| | - Won-Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Francesco Maisano
- Cardio-Thoracic-Vascular Department, IRCCS Ospedale San Raffaele, Milan, Italy
| | - Nicolas M Van Mieghem
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands
| | - Antonio Colombo
- Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Bernhard Reimers
- Cardio Center, IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Azeem Latib
- Division of Cardiology, Montefiore Medical Center, Bronx, New York, USA
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8
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Caus T, Chabry Y, Nader J, Fusellier JF, De Brux JL. Trends in SAVR with biological vs. mechanical valves in middle-aged patients: results from a French large multi-centric survey. Front Cardiovasc Med 2023; 10:1205770. [PMID: 37701140 PMCID: PMC10493300 DOI: 10.3389/fcvm.2023.1205770] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 06/16/2023] [Indexed: 09/14/2023] Open
Abstract
Background/introduction Currently, despite continued issues with durability ( 1), biological prosthetic valves are increasingly chosen over mechanical valves for surgical aortic valve replacement (SAVR) in adult patients of all ages, at least in Western countries. For younger patients, this choice means assuming the risks associated with a redo SAVR or valve-in-valve procedure. Purpose To assess the use of mechanical vs. biological valve prostheses for SAVR relative to patient's age and implant time in a large population extracted from the French National Database EPICARD. Methods Patients in EPICARD undergoing SAVR from 2007 to 2022 were included from 22 participating public or private centers chosen to represent a balanced representation of centre sizes and geographical discrepancies. Patients with associated pathology of the aorta (aneurysm or dissection) and requiring a vascular aortic prosthesis were excluded. Comparisons were made amongst centers, valve choice, implant date range, and patient age. Results We considered 101,070 valvular heart disease patients and included 72,375 SAVR (mean age 71.4 ± 12.2 years). We observed a mechanical vs. biological prosthesis ratio (MBPR) of 0.14 for the overall population. Before 50 years old (y-o), MBPR was >1.3 (p < 0.001) while patients above 60 years-old received principally biological SAVR (p < 0.0001). Concerning patients between 50 and 60 years-old patients, MPVR was 1.04 (p = 0.03). Patients 50-60 years-old from the first and second study duration quartile (before August 2015) received preferentially mechanical SAVR (p < 0.001). We observed a shift towards more biological SAVR (p < 0.001) for patients from the third and fourth quartile to reach a MBPR at 0.43 during the last years of the series. Incidentally, simultaneous mitral valve replacement were more common in case of mechanical SAVR (p < 0.0001), while associated CABGs were more frequent in case of biological SAVR (p < 0.0001). Conclusion In a large contemporary French patient population, real world practice showed a recent shift towards a lower age-threshold for biological SAVR as compared to what would suggest contemporary guidelines.
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Affiliation(s)
- Thierry Caus
- Department of Cardiac Surgery University Hospital Amiens-Picardie, Amiens, France
- Laboratoire MP3CV-University Picarde Jules Vernes-UR7517, Amiens, France
| | - Yuthiline Chabry
- Laboratoire MP3CV-University Picarde Jules Vernes-UR7517, Amiens, France
- Department of Cardiac Surgery University Paris Diderot, Paris, France
| | - Joseph Nader
- Department of Thoracic and Cardiovascular Surgery, Clinique du Millénaire, Montpellier, France
| | | | - Jean Louis De Brux
- Department of Cardiac Surgery, University Hospital of Angers, Angers, France
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9
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Lin MT, Chen CA, Chen SJ, Huang JH, Chang YH, Chiu SN, Lu CW, Wu MH, Wang JK. Self-Expanding Pulmonary Valves in 53 Patients With Native Repaired Right Ventricular Outflow Tracts. Can J Cardiol 2023; 39:997-1006. [PMID: 36933796 DOI: 10.1016/j.cjca.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2022] [Revised: 02/18/2023] [Accepted: 03/12/2023] [Indexed: 03/18/2023] Open
Abstract
BACKGROUND Self-expanding pulmonary valve grafts have been designed for percutaneous pulmonary valve implantation (PPVI) in patients with native repaired right ventricular (RV) outflow tracts (RVOTs). However, their efficacy, in terms of RV function and graft remodelling remain unclear. METHODS Patients with native RVOTs who received Venus P-valve (N = 15) or Pulsta valve (N = 38) implants between 2017 and 2022 were enrolled. We collected data on patient characteristics and cardiac catheterization parameters as well as imaging and laboratory data before, immediately after, and 6 to 12 months after PPVI and identified risk factors for RV dysfunction. RESULTS Valve implantation was successful in 98.1% of patients. The median duration of follow-up was 27.5 months. In the first 6 months after PPVI, all patients exhibited resolution of paradoxical septal motion and a significant reduction (P < 0.05) in RV volume, N-terminal pro-B-type natriuretic peptide levels, and valve eccentricity indices (-3.9%). Normalization of the RV ejection fraction (≥ 50%) was detected in only 9 patients (17.3%) and was independently associated with the RV end-diastolic volume index before PPVI (P = 0.03). Nine patients had residual or recurrent pulmonary regurgitation or paravalvular leak (graded as ≥ mild), which was associated with a larger eccentricity index (> 8%) and subsided by 12 months postimplantation. CONCLUSIONS We identified the risk factors likely to be associated with RV dysfunction and pulmonary regurgitation following PPVI in patients with native repaired RVOTs. RV volume-based patient selection is recommended for PPVI of a self-expanding pulmonary valve, along with monitoring of graft geometry.
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Affiliation(s)
- Ming-Tai Lin
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-An Chen
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Shyh-Jye Chen
- Department of Medical Imaging, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Jou-Hsuan Huang
- Department of Medical Imaging, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Yu-Hsuan Chang
- Department of Medical Imaging, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Shuenn-Nan Chiu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Chun-Wei Lu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Mei-Hwan Wu
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan
| | - Jou-Kou Wang
- Department of Pediatrics, National Taiwan University Hospital and Medical College, National Taiwan University, Taipei, Taiwan.
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10
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Huang X, Zhang G, Zhou X, Yang X. A review of numerical simulation in transcatheter aortic valve replacement decision optimization. Clin Biomech (Bristol, Avon) 2023; 106:106003. [PMID: 37245279 DOI: 10.1016/j.clinbiomech.2023.106003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Recent trials indicated a further expansion of clinical indication of transcatheter aortic valve replacement to younger and low-risk patients. Factors related to longer-term complications are becoming more important for use in these patients. Accumulating evidence indicates that numerical simulation plays a significant role in improving the outcome of transcatheter aortic valve replacement. Understanding mechanical features' magnitude, pattern, and duration is a topic of ongoing relevance. METHODS We searched the PubMed database using keywords such as "transcatheter aortic valve replacement" and "numerical simulation" and reviewed and summarized relevant literature. FINDINGS This review integrated recently published evidence into three subtopics: 1) prediction of transcatheter aortic valve replacement outcomes through numerical simulation, 2) implications for surgeons, and 3) trends in transcatheter aortic valve replacement numerical simulation. INTERPRETATIONS Our study offers a comprehensive overview of the utilization of numerical simulation in the context of transcatheter aortic valve replacement, and highlights the advantages, potential challenges from a clinical standpoint. The convergence of medicine and engineering plays a pivotal role in enhancing the outcomes of transcatheter aortic valve replacement. Numerical simulation has provided evidence of potential utility for tailored treatments.
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Affiliation(s)
- Xuan Huang
- Department of Cardiovascular Surgery, West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China
| | - Guangming Zhang
- Center for Computational Systems Medicine, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Xiaobo Zhou
- Center for Computational Systems Medicine, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Xiaoyan Yang
- Department of Cardiovascular Surgery, West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China.
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11
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Fukui M, Sorajja P, Cavalcante JL, Thao KR, Okada A, Sato H, Wang C, Koike H, Hamid N, Enriquez-Sarano M, Lesser JR, Bapat VN. Deformation of Transcatheter Heart Valve Following Valve-in-Valve Transcatheter Aortic Valve Replacement: Implications for Hemodynamics. JACC Cardiovasc Interv 2023; 16:515-526. [PMID: 36922036 DOI: 10.1016/j.jcin.2023.01.017] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Revised: 12/23/2022] [Accepted: 01/10/2023] [Indexed: 03/18/2023]
Abstract
BACKGROUND Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) may be associated with adverse hemodynamics, which might affect clinical outcomes. OBJECTIVES This study sought to evaluate the extent and predictors of transcatheter heart valve (THV) deformity in ViV TAVR and the relation to postprocedural hemodynamics. METHODS We examined 53 patients who underwent ViV TAVR in surgical heart valves with self-expanding Evolut prostheses. THV deformation was examined using cardiac computed tomography prospectively performed 30 days after ViV TAVR, and correlated with 30-day echocardiographic hemodynamic data. RESULTS Near complete expansion of the functional portion of the implanted ViV prostheses (ie, >90%) was observed in 16 (30.2%) patients. Factors related to greater expansion of the functional portion and consequently larger neosinus volume were absence of polymer surgical frame, higher implantation and use of balloon aortic valvuloplasty or bioprosthetic valve fracture during the procedure (all P < 0.05). Underexpansion of the functional portion, but not the valve inflow frame, was closely associated with mean gradient and effective orifice area at 30 days on echocardiography, with and without adjustment for the sizes of the THV and surgical heart valve. CONCLUSIONS Underexpansion of the functional portion of THV prostheses is common during ViV TAVR, occurs more frequently with deep implantation and the presence of a polymer surgical stent frame, and is associated with worse postprocedural hemodynamics. Procedural techniques, such as higher implantation and balloon postdilatation, may be used to help overcome problems with THV underexpansion and improve clinical outcomes.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Paul Sorajja
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Kiahltone R Thao
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Atsushi Okada
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Hirotomo Sato
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Cheng Wang
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Hideki Koike
- Cardiovascular Imaging Research Center and Core Lab, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA
| | - Nadira Hamid
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | | | - John R Lesser
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA
| | - Vinayak N Bapat
- Valve Science Center, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA; Minneapolis Heart Institute at Abbott Northwestern Hospital, Minneapolis, Minnesota, USA.
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12
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Helbock RT, Anam SB, Kovarovic BJ, Slepian MJ, Hamdan A, Haj-Ali R, Bluestein D. Designing a Novel Asymmetric Transcatheter Aortic Valve for Stenotic Bicuspid Aortic Valves Using Patient-Specific Computational Modeling. Ann Biomed Eng 2023; 51:58-70. [PMID: 36042099 DOI: 10.1007/s10439-022-03039-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 07/25/2022] [Indexed: 01/13/2023]
Abstract
Bicuspid aortic valve (BAV), the most common congenital heart malformation, is characterized by the presence of only two valve leaflets with asymmetrical geometry, resulting in elliptical systolic opening. BAV often leads to early onset of calcific aortic stenosis (AS). Following the rapid expansion of transcatheter aortic valve replacement (TAVR), designed specifically for treating conventional tricuspid AS, BAV patients with AS were initially treated "off-label" with TAVR, which recently gained FDA and CE regulatory approval. Despite its increasing use in BAV, pathological BAV anatomy often leads to complications stemming from mismatched anatomical features. To mitigate these complications, a novel eccentric polymeric TAVR valve incorporating asymmetrical leaflets was designed specifically for BAV anatomies. Computational modeling was used to optimize its asymmetric leaflets for lower functional stresses and improved hemodynamic performance. Deployment and flow were simulated in patient-specific BAV models (n = 6) and compared to a current commercial TAVR valve (Evolut R 29 mm), to assess deployment and flow parameters. The novel eccentric BAV-dedicated valve demonstrated significant improvements in peak systolic orifice area, along with lower jet velocity and wall shear stress (WSS). This feasibility study demonstrates the clinical potential of the first known BAV-dedicated TAVR design, which will foster advancement of patient-dedicated valvular devices.
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Affiliation(s)
- Ryan T Helbock
- Biofluids Research Group, Department of Biomedical Engineering, T8-050 Health Sciences Center, Stony Brook University, Stony Brook, NY11794-8084, USA
| | - Salwa B Anam
- Biofluids Research Group, Department of Biomedical Engineering, T8-050 Health Sciences Center, Stony Brook University, Stony Brook, NY11794-8084, USA
| | - Brandon J Kovarovic
- Biofluids Research Group, Department of Biomedical Engineering, T8-050 Health Sciences Center, Stony Brook University, Stony Brook, NY11794-8084, USA
| | - Marvin J Slepian
- Department of Medicine and Biomedical Engineering Sarver Heart Center, University of Arizona, Tucson, AZ, 85721, USA
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, 4941492, Petah Tikva, Israel
| | - Rami Haj-Ali
- School of Mechanical Engineering, Faculty of Engineering, Tel Aviv University, 69978, Tel Aviv, Ramat Aviv, Israel
| | - Danny Bluestein
- Biofluids Research Group, Department of Biomedical Engineering, T8-050 Health Sciences Center, Stony Brook University, Stony Brook, NY11794-8084, USA.
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13
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Orzalkiewicz M, Taglieri N, Palmerini T, Saia F. Overinflation of balloon-expandable valves for transcatheter treatment of pure noncalcified native aortic regurgitation: How much oversizing is needed and achievable? Catheter Cardiovasc Interv 2022; 101:481-484. [PMID: 36542666 DOI: 10.1002/ccd.30529] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Revised: 11/12/2022] [Accepted: 12/10/2022] [Indexed: 02/17/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) in noncalcified pure aortic valve regurgitation is challenging as dedicated valves are not widely available. We present a case series of four inoperable patients who underwent compassionate TAVI for this indication at our institution with a balloon-expandable valve. In this context, we analyzed the relevant technical aspects such as the need for larger oversizing of the transcatheter prosthesis and the safety and limits of valve overexpansion.
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Affiliation(s)
| | - Nevio Taglieri
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Tullio Palmerini
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Francesco Saia
- IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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14
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Qiu D, Azadani AN. Structural analysis of regional transcatheter aortic valve underexpansion and its implications for subclinical leaflet thrombosis. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3641. [PMID: 36054800 DOI: 10.1002/cnm.3641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/31/2022] [Accepted: 08/13/2022] [Indexed: 06/15/2023]
Abstract
Subclinical leaflet thrombosis has been increasingly recognized following transcatheter aortic valve replacement (TAVR). Determining the risk factors is vital in preventing clinical leaflet thrombosis and ensuring long-term value durability. Clinical data have indicated that regional stent under-expansion of transcatheter aortic valves (TAVs), particularly self-expanding devices, may be associated with an increased risk of subclinical leaflet thrombosis. This study aimed to determine the effects of regional TAV frame under-expansion on leaflet kinematics, leaflet structural characteristics, and explore its impact on the likelihood of leaflet thrombosis. In this study, mild and moderate regional frame under-expansion of a 26-mm CoreValve were examined using experimental testing and computational simulations. The results indicated that regional TAV frame under-expansion impairs leaflet kinematics and reduces the range of motion in leaflets with an angle less than 120°. The reduced range of motion can increase blood stasis on the surface of the TAV leaflets. The results also demonstrated that regional frame under-expansion induced localized high-stress regions in the leaflets close to the fixed boundary edge. The increased mechanical stress can lead to accelerated tissue degeneration. The study improves our understanding of the effects of regional stent under-expansion in TAVR. Post-procedural balloon dilatation of self-expanding TAVs can potentially be advantageous in reducing leaflet distortion and normalizing leaflet stress distribution. Large-scale, prospective, and well-controlled studies are needed to further investigate regional TAV frame under-expansion effects on subclinical leaflet thrombosis and long-term valve durability.
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Affiliation(s)
- Dong Qiu
- The DU Cardiovascular Biomechanics Laboratory, Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA
| | - Ali N Azadani
- The DU Cardiovascular Biomechanics Laboratory, Department of Mechanical and Materials Engineering, University of Denver, Denver, Colorado, USA
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15
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Bui HT, Ishrat A, James SP, Dasi LP. Design consideration of a novel polymeric transcatheter heart valve through computational modeling. J Mech Behav Biomed Mater 2022; 135:105434. [PMID: 36116342 DOI: 10.1016/j.jmbbm.2022.105434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/23/2022] [Accepted: 08/28/2022] [Indexed: 11/29/2022]
Abstract
Transcatheter heart valve replacement is becoming a more routine procedure, and this is further supported by positive outcomes from studies involving low-risk patients. Nevertheless, the lack of long-term transcatheter heart valve (TAV) durability is still one of the primary concerns. As a result, more research has been focused on improving durability through various methods such as valve design, computational modeling, and material selection. Recent advancements in polymeric valve fabrication showed that linear low-density polyethylene (LLDPE) could be used as leaflet material for transcatheter heart valves. In this paper, a parametric study of computational simulations showed stress distribution on the leaflets of LLDPE-TAV under diastolic load, and the results were used to improve the stent design. The in silico experiment also tested the effect of shock absorbers in terms of valve durability. The results demonstrated that altering specific stent angles can significantly lower peak stress on the leaflets (13.8 vs. 6.07 MPa). Implementing two layers of shock absorbers further reduces the stress value to 4.28 MPa. The pinwheeling index was assessed, which seems to correlate with peak stress. Overall, the parametric study and the computational method can be used to analyze and improve valve durability.
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Affiliation(s)
- Hieu T Bui
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Cir NW, Atlanta, GA, 30313, USA
| | - Amina Ishrat
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Cir NW, Atlanta, GA, 30313, USA
| | - Susan P James
- School of Advanced Materials Discovery, Colorado State University, 700 Meridian Ave, Fort Collins, CO, 80523, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Cir NW, Atlanta, GA, 30313, USA.
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16
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Sadat N, Bruhn D, Scharfschwerdt M, Schaller T, Aboud A, Saisho H, Eitel I, Ensminger S, Fujita B. Impact of high-pressure balloon aortic valvuloplasty on the hydrodynamic result after a transcatheter valve-in-valve procedure. Catheter Cardiovasc Interv 2022; 100:841-849. [PMID: 36040748 DOI: 10.1002/ccd.30359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2022] [Revised: 07/10/2022] [Accepted: 08/04/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVES The aim of this study was to investigate the degree of functional improvement of a transcatheter heart valve (THV) for valve-in-valve after bioprosthetic valve fracture (BVF) of three small surgical aortic valve bioprostheses (SAVBP) using high-pressure balloon aortic valvuloplasty (HP-BAV) under standardized ex-vivo-conditions. METHODS A THV 26 mm (Evolut R) and SAVBP 21 mm (Perimount Magna Ease, Trifecta, and Epic supra [n = 4] were used. Mean pressure gradient (MPG), effective orifice area (EOA), geometric orifice area (GOA), minimal internal diameter (MID), and pinwheeling index (PWI) were analyzed before and after HP-BAV of the SAVBP using a noncompliant balloon. Fracturing of the SAVBP was done before implantation of the THV and the balloon pressures at the point of fracture were recorded. RESULTS The Magna Ease and Epic fractured at balloon pressures of 18 and 8 atm, respectively. The Trifecta did not fracture up to a balloon pressure of 30 atm but was dilated. HP-BAV led to increased THV expansion as evident by straightened coaptation lines of the Evolut R 26 mm with reduced PWI, increased MID, and increased GOA in all 21 mm SAVBP. Evolut R showed significantly lower MPG and higher EOA as ViV in all prostheses after HP-BAV (p < 0.001). MPG and EOA of Evolut R differed regarding the SAVBP. Evolut R presented the lowest MPG and highest EOA in Magna Ease and the highest MPG and lowest EOA in Epic supra. CONCLUSIONS The degree of function improvement of the same THV as ViV after HP-BAV depends on the surgical valve model. Functional improvement can also be achieved without valve fracture.
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Affiliation(s)
- Najla Sadat
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Denise Bruhn
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Michael Scharfschwerdt
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Tim Schaller
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Anas Aboud
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Hiroyuki Saisho
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Ingo Eitel
- Department of Medicine II, Cardiology, Angiology and Intensive Care, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Stephan Ensminger
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
| | - Buntaro Fujita
- Department of Cardiac and Thoracic Vascular Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Lübeck, Germany
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17
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Fukui M, Bapat VN, Garcia S, Dworak MW, Hashimoto G, Sato H, Gössl M, Enriquez-Sarano M, Lesser JR, Cavalcante JL, Sorajja P. Deformation of Transcatheter Aortic Valve Prostheses: Implications for Hypoattenuating Leaflet Thickening and Clinical Outcomes. Circulation 2022; 146:480-493. [PMID: 35862182 DOI: 10.1161/circulationaha.121.058339] [Citation(s) in RCA: 39] [Impact Index Per Article: 19.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although transcatheter aortic valve replacement (TAVR) therapy continues to grow, there have been concerns about the occurrence of hypoattenuating leaflet thickening (HALT), which may affect prosthesis function or durability. This study aimed to examine prosthesis frame factors and correlate their extent to the frequency of HALT and clinical outcomes. METHODS We prospectively examined 565 patients with cardiac computed tomography screening for HALT at 30 days after balloon-expandable SAPIEN3 and self-expanding EVOLUT TAVR. Deformation of the TAVR prostheses, asymmetric prosthesis leaflet expansion, prosthesis sinus volumes, and commissural alignment were analyzed on the postprocedural computed tomography. For descriptive purposes, an index of prosthesis deformation was calculated, with values >1.00 representing relative midsegment underexpansion. A time-to-event model was performed to evaluate the association of HALT with the clinical outcome. RESULTS Overall, HALT was present in 21% of SAPIEN3 patients and in 16% of EVOLUT patients at 30 days after TAVR. The occurrence of HALT was directly associated with greater prosthesis frame deformation (P<0.001), worse asymmetry of the leaflets (P<0.001), and smaller TAVR neosinus volumes (P<0.001). These relations were present in both prosthetic types and in all of their size ranges (all P<0.05). In multivariable analyses that include clinical variables previously associated with HALT (eg, anticoagulant therapy), variables of TAVR prosthesis deformation remained predictive of HALT. Although HALT was not associated with changes in prosthetic hemodynamics, its presence was associated with the risk of mortality at 1 year, with respect to greater incidences of all-cause mortality (hazard ratio, 2.98 [95% CI, 1.57-5.63]; P=0.001), cardiac death (hazard ratio, 4.58 [95% CI, 1.81-11.6]; P=0.001), and a composite outcome of all-cause mortality and heart failure hospitalization (hazard ratio, 1.94 [95% CI, 1.14-3.30]; P=0.02) with adjustment for age, sex, and comorbidities. CONCLUSIONS Nonuniform expansion of TAVR prostheses resulting in frame deformation, asymmetric leaflet, and smaller neosinus volume is related to occurrence of HALT in patients who undergo TAVR. These data may have implications for both prosthesis valve design and deployment techniques to improve clinical outcomes for these patients.
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Affiliation(s)
- Miho Fukui
- Cardiovascular Imaging Research Center and Core Laboratory (M.F., G.H., J.L.C.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Vinayak N Bapat
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Santiago Garcia
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Marshall W Dworak
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Go Hashimoto
- Cardiovascular Imaging Research Center and Core Laboratory (M.F., G.H., J.L.C.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Hirotomo Sato
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Mario Gössl
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Maurice Enriquez-Sarano
- Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - John R Lesser
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - João L Cavalcante
- Cardiovascular Imaging Research Center and Core Laboratory (M.F., G.H., J.L.C.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
| | - Paul Sorajja
- Valve Science Center (V.N.B., S.G., M.W.D., H.S., M.G., M.E.-S., J.R.L., P.S.), Minneapolis Heart Institute Foundation, MN.,Minneapolis Heart Institute at Abbott Northwestern Hospital, MN (M.F., V.N.B., S.G., M.W.D., G.H., H.S., M.G., M.E.-S., J.R.L., J.L.C., P.S.)
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18
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Le Ruz R, Guérin P, Leurent G, Leroux L, Lefevre T, Nejjari M, Champagnac D, Tchétché D, Lhermusier T, Senage T, Piriou PG, Caussin C, Delomez M, Bonnet G, Favereau X, Karam N, Gerbay A, Juthier F, Gilard M, Obadia JF, Iung B, Manigold T. Mitral valve-in-valve and valve-in-ring procedures: Midterm outcomes in a French nationwide registry. Catheter Cardiovasc Interv 2022; 99:1829-1838. [PMID: 35324050 DOI: 10.1002/ccd.30161] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2021] [Revised: 01/31/2022] [Accepted: 03/05/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVES Report contemporary outcomes in patients included in the Mitragister registry and treated with transcatheter mitral valve implantation for failed surgical annuloplasty rings or deteriorated bioprosthesis. BACKGROUND Midterm survival rates have been reported, but little is known about contemporary morbimortality endpoints. METHODS The primary safety outcome was the technical success rate. The primary efficacy composite endpoint was a composite of cardiovascular mortality and heart failure hospitalizations. RESULTS From 2016 to 2021, 102 patients (median age: 81 [74;84] years, 61% female, Euroscore II 11.0% [7.8;16.0]) undergoing valve-in-valve (ViV; n = 89) or valve-in-ring (ViR; n = 13) procedures were consecutively included. At baseline, ViR group patients had worse left ventricular ejection fraction (50% vs. 60%; p = 0.004) and more frequently severe regurgitation (46% vs. 15%; p = 0.014). The primary safety outcome was 95%: 77% and 98% in the ViR and ViV populations, respectively, (p = 0.014). At intermediate follow-up (6-12 months) clinical improvement was notable, 88% of the patients were in NYHA class ≤ II (vs. 25% at baseline; p < 0.001). At a mean follow-up of 17.1 ± 11.0 months, the primary efficacy composite reached 27%. By multivariate analysis, paravalvular leak (PVL) was the only independent predictor (hazard ratio: 2.39, 95% confidence interval: 1.08-5.29; p = 0.031) while ViR was not found statistically associated (p = 0.456). CONCLUSIONS This study confirms the safety and efficacy of the mitral ViV procedure. ViR patients appear at higher risk of procedural complications. The presence of PVL could be associated with markedly worse midterm prognosis. Whatever the intervention, procedural strategies to reduce PVL incidence remain to be assessed to prevent latter adverse outcomes.
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Affiliation(s)
- Robin Le Ruz
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
| | - Patrice Guérin
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
| | - Guillaume Leurent
- Department of Cardiology, University Hospital of Rennes, Rennes, France
| | - Lionel Leroux
- CHU de Bordeaux, Service Médico-Chirurgical de Valvulopathies et Cardiomyopathies, Chirurgie Cardiaque Adulte, Cardiologie Interventionnelle Structurelle Adulte, Bordeaux, France
| | - Thierry Lefevre
- Department of Interventional Cardiology, Institut Cardiovasculaire Paris Sud, Massy, France
| | - Mohammed Nejjari
- Cardiology Department, Centre Cardiologique du Nord, Saint-Denis, France
| | | | - Didier Tchétché
- Department of Cardiology, Clinique Pasteur Toulouse, Toulouse, France
| | | | - Thomas Senage
- Department of Thoracic and Cardiovascular Surgery, PHU 2 Institut du Thorax et du Sytème Nerveux, CHU Nantes, Nantes, France
| | - Pierre-Guillaume Piriou
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
| | | | | | - Guillaume Bonnet
- Service de Cardiologie Interventionnelle, CHU Timone, Assistance Publique-Hôpitaux de Marseille, Marseille, France
| | - Xavier Favereau
- Private Hospital of Parly II, Le Chesnay-Rocquencourt, France
| | - Nicole Karam
- Cardiology Department, Université de Paris, PARCC, INSERM, European Hospital Georges Pompidou, Paris, France
| | - Antoine Gerbay
- Division of Cardiology, Jean Monnet University (ADC, CD, JBG, AG, RP, CRB, and KI), Saint-Etienne, France
| | | | - Martine Gilard
- Department of Cardiology, University Hospital of Brest, Brest, France
| | - Jean-Francois Obadia
- Department of Cardiac Surgery, "Louis Pradel" Cardiologic Hospital, Lyon, France
| | - Bernard Iung
- Department of Cardiology, University Hospital Department Fire and Paris-Diderot University, Public Assistance Hospitals of Paris, Bichat Hospital, Paris, France
| | - Thibaut Manigold
- Service de Cardiologie, Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Nantes, France
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19
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Busto L, Veiga C, González-Nóvoa JA, Loureiro-Ga M, Jiménez V, Baz JA, Íñiguez A. Automatic Identification of Bioprostheses on X-ray Angiographic Sequences of Transcatheter Aortic Valve Implantation Procedures Using Deep Learning. Diagnostics (Basel) 2022; 12:diagnostics12020334. [PMID: 35204425 PMCID: PMC8870761 DOI: 10.3390/diagnostics12020334] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/23/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has become the treatment of choice for patients with severe aortic stenosis and high surgical risk. Angiography has been established as an essential tool in TAVI, as this modality provides real-time images required to support the intervention. The automatic interpretation and parameter extraction on such images can lead to significative improvements and new applications in the procedure that, in most cases, rely on a prior identification of the transcatheter heart valve (THV). In this paper, U-Net architecture is proposed for the automatic segmentation of THV on angiographies, studying the role of its hyperparameters in the quality of the segmentations. Several experiments have been conducted, testing the methodology using multiple configurations and evaluating the results on different types of frames captured during the procedure. The evaluation has been performed in terms of conventional classification metrics, complemented with two new metrics, specifically defined for this problem. Those new metrics provide a more appropriate assessment of the quality of the results, given the class imbalance in the dataset. From an analysis of the evaluation results, it can be concluded that the method provides appropriate segmentation results for this dataset.
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Affiliation(s)
- Laura Busto
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), 36213 Vigo, Spain; (J.A.G.-N.); (M.L.-G.)
- Correspondence: (L.B.); (C.V.)
| | - César Veiga
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), 36213 Vigo, Spain; (J.A.G.-N.); (M.L.-G.)
- Correspondence: (L.B.); (C.V.)
| | - José A. González-Nóvoa
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), 36213 Vigo, Spain; (J.A.G.-N.); (M.L.-G.)
| | - Marcos Loureiro-Ga
- Cardiovascular Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), 36213 Vigo, Spain; (J.A.G.-N.); (M.L.-G.)
| | - Víctor Jiménez
- Cardiology Department, Complexo Hospitalario Universitario de Vigo (SERGAS), Álvaro Cunqueiro Hospital, 36213 Vigo, Spain; (V.J.); (J.A.B.); (A.Í.)
| | - José Antonio Baz
- Cardiology Department, Complexo Hospitalario Universitario de Vigo (SERGAS), Álvaro Cunqueiro Hospital, 36213 Vigo, Spain; (V.J.); (J.A.B.); (A.Í.)
| | - Andrés Íñiguez
- Cardiology Department, Complexo Hospitalario Universitario de Vigo (SERGAS), Álvaro Cunqueiro Hospital, 36213 Vigo, Spain; (V.J.); (J.A.B.); (A.Í.)
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20
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OUP accepted manuscript. Eur J Cardiothorac Surg 2022; 62:6554163. [DOI: 10.1093/ejcts/ezac158] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2021] [Revised: 02/23/2022] [Accepted: 02/24/2022] [Indexed: 11/14/2022] Open
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21
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Bressloff NW. Leaflet Stresses During Full Device Simulation of Crimping to 6 mm in Transcatheter Aortic Valve Implantation, TAVI. Cardiovasc Eng Technol 2022; 13:735-750. [PMID: 35230649 PMCID: PMC9616759 DOI: 10.1007/s13239-022-00614-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2021] [Accepted: 02/02/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND With continuing growth in transcatheter aortic valve implantation for the treatment of a failing aortic valve, there is increasing interest in prosthetic valve durability and the potential damage caused to leaflets by stress. Whilst most available research into the computational prediction of leaflet stresses using finite element analysis, FEA, has focussed on variations during dynamic loading, very little appears to have been reported for the impact of crimping, even though awareness of this effect is widespread. Potentially, this has been due to the difficulty of performing full model simulations of crimping to clinically meaningful diameters. METHOD A full model comprising a self-expanding frame, skirt and leaflets has been developed and crimped to a final diameter of 6 mm. A detailed description is provided of the FEA setup, emphasising the importance of the skirt definition needed to successfully crimp to this small diameter. Then, an analysis of leaflet folding and stresses is presented, particularly with respect to the differences produced between leaflet thicknesses of 0.20, 0.25 and 0.30 mm and for bioprosthetic and polymeric leaflet material models. RESULTS In all cases, peak stresses occurred close to the modelled suture lines joining the leaflets and the skirt and high stresses were also present along axially aligned folds in the leaflets. Stresses were lower for the polymeric leaflets. CONCLUSION Successful simulation of crimping requires a finely resolved skirt mesh. Leaflet stresses during crimping are dependent on leaflet thickness, material properties and the ratio of leaflet volume to the available volume inside the crimped valve.
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Affiliation(s)
- N. W. Bressloff
- grid.5491.90000 0004 1936 9297Faculty of Engineering & Physical Sciences, University of Southampton, Boldrewood Innovation Campus, Southampton, SO16 7QF UK
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22
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Xuan Y, Dvir D, Wisneski AD, Wang Z, Ye J, Guccione JM, Ge L, Tseng EE. Impact of Transcatheter Aortic Valve Size on Leaflet Stresses: Implications for Durability and Optimal Grey Zone Sizing. ACTA ACUST UNITED AC 2021; 6:64-71. [PMID: 34708162 DOI: 10.4244/aij-d-19-00005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Aims As indications for transcatheter aortic valve replacement (TAVR) continue to expand towards younger and lower-risk patients, durability becomes an increasingly important question. Durability decreases as leaflet stresses increase, but the impact of transcatheter heart valve (THV) size on stress is unknown. Patient annulus sizes can fall within "grey zones" between 2 TAVR sizes. Our aim was to examine the impact of balloon-expandable THV size on leaflet stresses. Methods and Results SapienXT 23mm, 26mm, and 29mm sizes (Edwards Lifesciences, Inc) underwent micro-computed tomography scanning to create THV computational models then loaded to systemic pressure using finite element software. THV leaflet maximum principal stresses were 1.69MPa (23mm), 1.70MPa (26mm), and 2.12MPa (29mm) at mean arterial pressure. For intermediate annulus sizes, undersizing the larger THV yielded lower leaflet stresses than oversizing the smaller THV. Conclusions Increasing THV size yielded greater leaflet maximum principal stresses, which could suggest a relationship between THV size and long-term durability.. For annulus "grey zones" sizes, undersizing the larger THV resulted in lower leaflet stresses than oversizing the smaller THV. These results may influence optimal device sizing, as THV durability remains an important, unanswered question.
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Affiliation(s)
- Yue Xuan
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, CA
| | - Danny Dvir
- Division of Cardiology, University of Washington, Seattle, WA
| | - Andrew D Wisneski
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, CA
| | - Zhongjie Wang
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, CA
| | - Jian Ye
- Division of Cardiovascular Surgery, St. Paul's Hospital and Vancouver General Hospital, Vancouver, BC, Canada
| | - Julius M Guccione
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, CA
| | - Liang Ge
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, CA
| | - Elaine E Tseng
- Department of Surgery, University of California San Francisco and San Francisco VA Medical Centers, San Francisco, CA
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23
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Bui HT, Khair N, Yeats B, Gooden S, James SP, Dasi LP. Transcatheter Heart Valves: A Biomaterials Perspective. Adv Healthc Mater 2021; 10:e2100115. [PMID: 34038627 DOI: 10.1002/adhm.202100115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/23/2021] [Indexed: 11/11/2022]
Abstract
Heart valve disease is prevalent throughout the world, and the number of heart valve replacements is expected to increase rapidly in the coming years. Transcatheter heart valve replacement (THVR) provides a safe and minimally invasive means for heart valve replacement in high-risk patients. The latest clinical data demonstrates that THVR is a practical solution for low-risk patients. Despite these promising results, there is no long-term (>20 years) durability data on transcatheter heart valves (THVs), raising concerns about material degeneration and long-term performance. This review presents a detailed account of the materials development for THVRs. It provides a brief overview of THVR, the native valve properties, the criteria for an ideal THV, and how these devices are tested. A comprehensive review of materials and their applications in THVR, including how these materials are fabricated, prepared, and assembled into THVs is presented, followed by a discussion of current and future THVR biomaterial trends. The field of THVR is proliferating, and this review serves as a guide for understanding the development of THVs from a materials science and engineering perspective.
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Affiliation(s)
- Hieu T. Bui
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Nipa Khair
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Breandan Yeats
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Shelley Gooden
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Susan P. James
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
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24
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Le Ruz R, Plessis J, Houeijeh A, Baruteau AE, Le Gloan L, Warin Fresse K, Karsenty C, Petit J, Godart F, Hascoët S, Guérin P. Edwards SAPIEN XT transcatheter pulmonary valve implantation: 5-year follow-up in a French Registry. Catheter Cardiovasc Interv 2021; 98:990-999. [PMID: 34227735 DOI: 10.1002/ccd.29862] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 06/08/2021] [Accepted: 06/18/2021] [Indexed: 11/09/2022]
Abstract
OBJECTIVES This study sought to investigate patient intermediate-term outcomes after transcatheter pulmonary valve replacement (TPVR) with Edwards SAPIEN valve. BACKGROUND The Edwards SAPIEN valve, initially designed for percutaneous aortic valve replacement, has been approved for TPVR in patients with dysfunctional right ventricular outflow tracts (RVOT), but only short-term follow-up has been reported. METHODS From 2011 to 2016, 62 patients undergoing successful TPVR using the SAPIEN XT valve were consecutively included into the study. Primary efficacy and safety endpoints were defined as freedom from valve-reintervention and freedom from infective endocarditis at last follow-up, respectively. RESULTS The primary efficacy outcome was met for 87.1% patients after a mean follow-up of 4.6 ± 1.8 years, corresponding to a freedom of reintervention at 5 years of 89% (95% CI 74.8-95.6%). Reinterventions were exclusively due to recurrent obstruction, no significant valvular regurgitation was observed. One case of infective endocarditis was reported, corresponding to a rate of 0.35% per patient-year (95% CI 0.01-2.00%). At 5 years, freedom from infective endocarditis was 98.4% (95% CI 89.1-99.8%). Six patients died or were transplanted due to advanced cardiac failure, without relationship with TPVR. In univariate analysis, reintervention was associated with young age, a smaller tube-graft, a higher pulmonary valve gradient after the procedure and a ratio of largest implanted stent diameter to invasive balloon conduit diameter over 1.35. CONCLUSIONS This study documents the mid-term safety and efficacy of the Edwards SAPIEN XT valve in patients with dysfunctional RVOT, and identifies a patient profile associated with an uncertain benefit-risk balance.
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Affiliation(s)
- Robin Le Ruz
- Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Service de Cardiologie, Nantes, France
| | - Julien Plessis
- Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Service de Cardiologie, Nantes, France
| | - Ali Houeijeh
- Centre Hospitalier Régional Universitaire de Lille, Service de Cardiologie Infantile et Congénitale, Nantes, France.,Hôpital Marie Lannelongue, Pole de Chirurgie des Cardiopathies Congénitales, Groupe hospitalier Paris Saint Joseph, M3C- Centre de Reference Malformations Cardiaques Congénitales Complexes, Université Paris-Saclayl, Paris, France
| | - Alban-Elouen Baruteau
- Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Service de Cardiologie, Nantes, France.,L'institut du thorax, INSERM, CNRS, UNIV Nantes, CHU Nantes, Nantes, France.,Department of Pediatric Cardiology and Pediatric Cardiac Surgery, M3C Regional Reference Center, CHU Nantes, Nantes, France.,Department of Congenital Cardiology, Evelina London Children's Hospital, Guy's and St Thomas' NHS Foundation Trust, London, UK
| | - Laurianne Le Gloan
- Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Service de Cardiologie, Nantes, France
| | - Karine Warin Fresse
- Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Service de Cardiologie, Nantes, France
| | - Clément Karsenty
- Hôpital Marie Lannelongue, Pole de Chirurgie des Cardiopathies Congénitales, Groupe hospitalier Paris Saint Joseph, M3C- Centre de Reference Malformations Cardiaques Congénitales Complexes, Université Paris-Saclayl, Paris, France.,Paediatric and Congenital Cardiology, Children's Hospital, CHU Toulouse, Toulouse University, Toulouse, France
| | - Jérôme Petit
- Hôpital Marie Lannelongue, Pole de Chirurgie des Cardiopathies Congénitales, Groupe hospitalier Paris Saint Joseph, M3C- Centre de Reference Malformations Cardiaques Congénitales Complexes, Université Paris-Saclayl, Paris, France
| | - François Godart
- Centre Hospitalier Régional Universitaire de Lille, Service de Cardiologie Infantile et Congénitale, Nantes, France
| | - Sébastien Hascoët
- Hôpital Marie Lannelongue, Pole de Chirurgie des Cardiopathies Congénitales, Groupe hospitalier Paris Saint Joseph, M3C- Centre de Reference Malformations Cardiaques Congénitales Complexes, Université Paris-Saclayl, Paris, France.,INSERM UMR-S999, Hôpital Marie Lannelongue, Université Paris-Saclay, Paris, France
| | - Patrice Guérin
- Centre Hospitalier Universitaire de Nantes, Institut du Thorax, Fédération des Cardiopathies Congénitales, Service de Cardiologie, Nantes, France
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25
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Kusner J, Luraghi G, Khodaee F, Rodriguez Matas JF, Migliavacca F, Edelman ER, Nezami FR. Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study. PLoS One 2021; 16:e0251579. [PMID: 33999969 PMCID: PMC8128244 DOI: 10.1371/journal.pone.0251579] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 04/29/2021] [Indexed: 12/23/2022] Open
Abstract
The bicuspid aortic valve (BAV) is a common and heterogeneous congenital heart abnormality that is often complicated by aortic stenosis. Although initially developed for tricuspid aortic valves (TAV), transcatheter aortic valve replacement (TAVR) devices are increasingly applied to the treatment of BAV stenosis. It is known that patient-device relationship between TAVR and BAV are not equivalent to those observed in TAV but the nature of these differences are not well understood. We sought to better understand the patient-device relationships between TAVR devices and the two most common morphologies of BAV. We performed finite element simulation of TAVR deployment into three cases of idealized aortic anatomies (TAV, Sievers 0 BAV, Sievers 1 BAV), derived from patient-specific measurements. Valve leaflet von Mises stress at the aortic commissures differed by valve configuration over a ten-fold range (TAV: 0.55 MPa, Sievers 0: 6.64 MPa, and Sievers 1: 4.19 MPa). First principle stress on the aortic wall was greater in Sievers 1 (0.316 MPa) and Sievers 0 BAV (0.137 MPa) compared to TAV (0.056 MPa). TAVR placement in Sievers 1 BAV demonstrated significant device asymmetric alignment, with 1.09 mm of displacement between the center of the device measured at the annulus and at the leaflet free edge. This orifice displacement was marginal in TAV (0.33 mm) and even lower in Sievers 0 BAV (0.23 mm). BAV TAVR, depending on the subtype involved, may encounter disparate combinations of device under expansion and asymmetry compared to TAV deployment. Understanding the impacts of BAV morphology on patient-device relationships can help improve device selection, patient eligibility, and the overall safety of TAVR in BAV.
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Affiliation(s)
- Jonathan Kusner
- Harvard Medical School, Boston, MA, United States of America
| | - Giulia Luraghi
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering ‘Giulio Natta’, Politecnico di Milano, Milan, Italy
| | - Farhan Khodaee
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
| | - José Félix Rodriguez Matas
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering ‘Giulio Natta’, Politecnico di Milano, Milan, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering ‘Giulio Natta’, Politecnico di Milano, Milan, Italy
| | - Elazer R. Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Cardiovascular Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
| | - Farhad R. Nezami
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, United States of America
- Thoracic and Cardiac Surgery Division, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA, United States of America
- * E-mail: ,
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26
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Greason KL. Repeat surgical aortic valve replacement: Don't stick a fork in it just yet. J Thorac Cardiovasc Surg 2021; 163:940-943. [PMID: 33685729 DOI: 10.1016/j.jtcvs.2020.12.147] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2020] [Revised: 11/17/2020] [Accepted: 12/21/2020] [Indexed: 11/26/2022]
Affiliation(s)
- Kevin L Greason
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn.
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Bugani G, Pagnesi M, Tchetchè D, Kim WK, Khokhar A, Sinning JM, Landes U, Kornowski R, Codner P, De Backer O, Nickenig G, Ielasi A, De Biase C, Søndergaard L, De Marco F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Tespili M, Laricchia A, Latib A, Giannini F, Colombo A, Mangieri A. Predictors of high residual gradient after transcatheter aortic valve replacement in bicuspid aortic valve stenosis. Clin Res Cardiol 2021; 110:667-675. [PMID: 33389062 DOI: 10.1007/s00392-020-01793-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Accepted: 12/09/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To define the incidence of high residual gradient (HRG) after transcatheter aortic valve replacement (TAVR) in BAVs and their impact on short term outcome and 1-year mortality. BACKGROUND Transcatheter heart valves (THVs) offer good performance in tricuspid aortic valves with low rate of HRG. However, data regarding their performance in bicuspid aortic valves (BAV) are still lacking. METHODS The BEAT (Balloon vs Self-Expandable valve for the treatment of bicuspid Aortic valve sTenosis) registry included 353 consecutive patients who underwent TAVR (Evolut R/PRO or Sapien 3 valves) in BAV between June 2013 and October 2018. The primary endpoint was device unsuccess with post-procedural HRG (mean gradient ≥ 20 mmHg). The secondary endpoint was to identify the predictors of HRG following the procedure. RESULTS Twenty patients (5.6%) showed HRG after TAVR. Patients with HRG presented higher body mass index (BMI) (30.7 ± 9.3 vs. 25.9 ± 4.8; p < 0.0001) and higher baseline aortic mean gradients (57.6 ± 13.4 mmHg vs. 47.7 ± 16.6, p = 0.013) and more often presented with BAV of Sievers type 0 than patients without HRG. At multivariate analysis, BMI [odds ratio (OR) 1.12; 95% confidence interval (CI) 1.05-1.20, p = 0.001] and BAV type 0 (OR 11.31, 95% CI 3.45-37.06, p < 0.0001) were confirmed as independent predictors of high gradient. CONCLUSION HRG following TAVR in BAVs is not negligible and is higher among patients with high BMI and with BAV 0 anatomy.
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Affiliation(s)
- Giulia Bugani
- Cardiology Unit, Azienda Ospedaliero Universitaria di Ferrara Arcispedale Sant'Anna, Ferrara, Italy
| | | | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Won- Keun Kim
- Department of Cardiology, Kerckhoff Heart Center, Bad Nauheim, Germany
| | - Arif Khokhar
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | | | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Pablo Codner
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Bonn, Germany
| | | | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Damiano Regazzoli
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio Stefanini
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany.,Anglia Ruskin University, Chelmsford, UK
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | | | - Alessandra Laricchia
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, New York, NY, USA.,Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Francesco Giannini
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy
| | - Antonio Colombo
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy.,EMO GVM Centro Cuore Columbus, Milan, Italy
| | - Antonio Mangieri
- Interventional Cardiology Unit, GVM Care and Research, Maria Cecilia Hospital, via della Corriera 1, 48033, Cotignola, Ravenna, Italy.
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Ielasi A, Moscarella E, Mangieri A, Giannini F, Tchetchè D, Kim WK, Sinning JM, Landes U, Kornowski R, De Backer O, Nickenig G, De Biase C, Søndergaard L, De Marco F, Bedogni F, Ancona M, Montorfano M, Regazzoli D, Stefanini G, Toggweiler S, Tamburino C, Immè S, Tarantini G, Sievert H, Schäfer U, Kempfert J, Wöehrle J, Latib A, Calabrò P, Medda M, Tespili M, Colombo A. Procedural and clinical outcomes of type 0 versus type 1 bicuspid aortic valve stenosis undergoing trans-catheter valve replacement with new generation devices: Insight from the BEAT international collaborative registry. Int J Cardiol 2020; 325:109-114. [PMID: 33148461 DOI: 10.1016/j.ijcard.2020.10.050] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/01/2020] [Accepted: 10/15/2020] [Indexed: 10/23/2022]
Abstract
BACKGROUND Although bicuspid aortic valve (BAV) is not considered a "sweet spot" to trans-catheter aortic valve replacement (TAVR), a certain number of BAV underwent TAVR. Whether BAV phenotype affects outcomes following TAVR remains debated. We aimed at evaluating the impact of BAV phenotype on procedural and clinical outcomes after TAVR using new generation trans-catheter heart valves (THVs). METHODS patients included in the BEAT registry were classified according to the BAV phenotype revealed at multi-slice computed tomography (MSCT) in type 0 (no raphe) vs. type 1 (1 raphe). Primary end-point was Valve Academic Research Consortium-2 (VARC-2) device success. Secondary end-points included procedural complications, rate of permanent pacemaker implantation, clinical outcomes at 30-day and 1-year. RESULTS Type 0 BAV was present in 25(7.1%) cases, type 1 in 218(61.8%). Baseline characteristics were well balanced between groups. Moderate-severe aortic valve calcifications at MSCT were less frequently present in type 0 vs. type 1 (52%vs.71.1%,p = 0.05). No differences were reported for THV type, size, pre and post-dilation between groups. VARC-2 success tended to be lower in type 0 vs. type 1 BAV (72%vs86.7%;p = 0.07). Higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 group (24%vs6%,p = 0.007). No differences were reported in the rate of post-TAVR moderate-severe aortic regurgitation and clinical outcomes between groups. CONCLUSIONS Our study confirms TAVR feasibility in both BAV types, however a trend toward a lower VARC-2 device success and a higher rate of mean transprosthetic gradient ≥20 mmHg was observed in type 0 vs. type 1 BAV.
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Affiliation(s)
- Alfonso Ielasi
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy, Italy.
| | - Elisabetta Moscarella
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Antonio Mangieri
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Francesco Giannini
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy
| | - Didier Tchetchè
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | - Won-Keun Kim
- Kerckhoff Heart Center, Department of Cardiology, Bad Nauheim, Germany
| | | | - Uri Landes
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ran Kornowski
- Cardiology Department, Rabin Medical Center, Petah Tikva, Israel
| | - Ole De Backer
- The Heart Center-Rigshospitalet, Copenhagen, Denmark
| | - Georg Nickenig
- Cardiology Department, University Hospital Bonn, Bonn, Germany
| | - Chiara De Biase
- Groupe CardioVasculaire Interventionnel, Clinique Pasteur, Toulouse, France
| | | | - Federico De Marco
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | - Francesco Bedogni
- Department of Cardiology, IRCCS Policlinico San Donato, Milan, Italy
| | | | | | - Damiano Regazzoli
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giulio Stefanini
- Clinical and Interventional Cardiology Unit, Cardio Center, Humanitas Research Hospital, Rozzano, Milan, Italy
| | | | - Corrado Tamburino
- Cardiology Division, CAST Policlinico Hospital, University of Catania, Catania, Italy
| | | | | | - Horst Sievert
- Cardiovascular Center Frankfurt, Frankfurt, Germany and Anglia Ruskin University, Chelmsford, United Kingdom
| | | | - Jörg Kempfert
- Deutsches Herzzentrum Berlin, Charité Universitätsmedizin, Berlin, Germany
| | | | - Azeem Latib
- Department of Cardiology, Montefiore Medical Center, NY, New York, United States of America; Division of Cardiology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Paolo Calabrò
- Department of Translational Medical Sciences, University of Campania "Luigi Vanvitelli", Naples, Italy
| | - Massimo Medda
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy, Italy
| | - Maurizio Tespili
- Clinical and Interventional Cardiology Unit, Istituto Clinico Sant'Ambrogio, Milan, Italy, Italy
| | - Antonio Colombo
- GVM Care and Research, Maria Cecilia Hospital, Cotignola, Ravenna, Italy; EMO GVM Centro Cuore Columbus, Milan, Italy
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Iannopollo G, Romano V, Buzzatti N, Ancona M, Ferri L, Russo F, Bellini B, Granada JF, Chieffo A, Montorfano M. Supra-annular sizing of transcatheter aortic valve prostheses in raphe-type bicuspid aortic valve disease: the LIRA method. Int J Cardiol 2020; 317:144-151. [DOI: 10.1016/j.ijcard.2020.05.076] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/21/2020] [Accepted: 05/24/2020] [Indexed: 12/23/2022]
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30
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Pibarot P, Ternacle J, Jaber WA, Salaun E, Dahou A, Asch FM, Weissman NJ, Rodriguez L, Xu K, Annabi MS, Guzzetti E, Beaudoin J, Bernier M, Leipsic J, Blanke P, Clavel MA, Rogers E, Alu MC, Douglas PS, Makkar R, Miller DC, Kapadia SR, Mack MJ, Webb JG, Kodali SK, Smith CR, Herrmann HC, Thourani VH, Leon MB, Hahn RT. Structural Deterioration of Transcatheter Versus Surgical Aortic Valve Bioprostheses in the PARTNER-2 Trial. J Am Coll Cardiol 2020; 76:1830-1843. [DOI: 10.1016/j.jacc.2020.08.049] [Citation(s) in RCA: 63] [Impact Index Per Article: 15.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Revised: 08/20/2020] [Accepted: 08/21/2020] [Indexed: 02/07/2023]
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Hatoum H, Gooden S, Heitkemper M, Blum KM, Zakko J, Bocks M, Yi T, Wu YL, Wang Y, Breuer CK, Dasi LP. Fetal Transcatheter Trileaflet Heart Valve Hemodynamics: Implications of Scaling on Valve Mechanics and Turbulence. Ann Biomed Eng 2020; 48:1683-1693. [PMID: 32052320 PMCID: PMC7286783 DOI: 10.1007/s10439-020-02475-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/05/2020] [Indexed: 01/09/2023]
Abstract
The scarcity of data available on the best approach for pulmonary fetal valve replacement or implantation necessitate an investigation on whether practices using adult transcatheter valves could be translated to fetal applications. The objective of this study is to evaluate the hemodynamic characteristics and the turbulent properties of a fetal sized trileaflet transcatheter pulmonary valve in comparison with an adult balloon-expandable valve in order to assess the possibility of designing valves for fetal applications using dynamic similarity. A 6 mm fetal trileaflet valve and a 26 mm SAPIEN 3 valve were assessed in a pulse duplicator. Particle image velocimetry was performed. Pressure gradient (ΔP), effective orifice area (EOA), regurgitant fractions (RF), pinwheeling indices (PI) and turbulent stresses were evaluated. ΔP was 8.56 ± 0.139 and 7.76 ± 0.083 mmHg with fetal valve and SAPIEN respectively (p < 0.0001); EOA was 0.10 ± 0.0007 and 2.1 ± 0.025 cm2 with fetal valve and SAPIEN respectively (p < 0.0001); RF with the fetal valve was 2.35 ± 1.99% and with SAPIEN 10.92 ± 0.11% (p < 0.0001); PI with fetal valve was 0.404 ± 0.01 and with SAPIEN 0.37 ± 0.07; The flow regime with the fetal valve was turbulent and Reynolds numbers reached about 7000 while those with the SAPIEN reached about 20,000 at peak velocity. Turbulent stresses were significantly higher with fetal valve compared with SAPIEN. Instantaneous viscous shear stresses with fetal valve were 5.8 times higher than those obtained with SAPIEN and Reynolds shear stresses were 2.5 times higher during peak systole. The fetal valve implantation leads to a turbulent flow (specific to this particular type and design of valve) regime unlike what is expected of a small valve with different flow properties compared to adult valves.
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Affiliation(s)
- Hoda Hatoum
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle NW, Atlanta, GA, 30313, USA
| | - Shelley Gooden
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle NW, Atlanta, GA, 30313, USA
| | - Megan Heitkemper
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Kevin M Blum
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jason Zakko
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Martin Bocks
- Case Western Reserve University School of Medicine, UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Tai Yi
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Yen-Lin Wu
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Yadong Wang
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Lakshmi Prasad Dasi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle NW, Atlanta, GA, 30313, USA.
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Travaglino S, Murdock K, Tran A, Martin C, Liang L, Wang Y, Sun W. Computational Optimization Study of Transcatheter Aortic Valve Leaflet Design Using Porcine and Bovine Leaflets. J Biomech Eng 2020; 142:011007. [PMID: 31314886 DOI: 10.1115/1.4044244] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2018] [Indexed: 07/25/2024]
Abstract
In this study, a Bayesian optimization (BO) based computational framework is developed to investigate the design of transcatheter aortic valve (TAV) leaflets and to optimize leaflet geometry such that its peak stress under the blood pressure of 120 mmHg is reduced. A generic TAV model is parametrized by mathematical equations describing its 2D shape and its 3D stent-leaflet assembly line. Material properties previously obtained for bovine pericardium (BP) and porcine pericardium (PP) via a combination of flexural and biaxial tensile testing were incorporated into the finite element (FE) model of TAV. A BO approach was employed to investigate about 1000 leaflet designs for each material under the nominal circular deployment and physiological loading conditions. The optimal parameter values of the TAV model were obtained, corresponding to leaflet shapes that can reduce the peak stress by 16.7% in BP and 18.0% in PP, compared with that from the initial generic TAV model. Furthermore, it was observed that while peak stresses tend to concentrate near the stent-leaflet attachment edge, optimized geometries benefit from more uniform stress distributions in the leaflet circumferential direction. Our analysis also showed that increasing leaflet contact area redistributes peak stresses to the belly region contributing to peak stress reduction. The results from this study may inspire new TAV designs that can have better durability.
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Affiliation(s)
- Stefano Travaglino
- Tissue Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, GA, 30313-2412
| | - Kyle Murdock
- Tissue Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, GA, 30313-2412
| | - Anh Tran
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0405
| | - Caitlin Martin
- Tissue Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Atlanta, GA, 30313-2412
| | - Liang Liang
- Department of Computer Science, University of Miami, Coral Gables, FL, 33124
| | - Yan Wang
- Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA 30332-0405
| | - Wei Sun
- Tissue Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Technology Enterprise Park, Room 206 387 Technology Circle, Atlanta, GA 30313-2412
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Sathananthan J, Sellers S, Barlow AM, Stanová V, Fraser R, Toggweiler S, Allen KB, Chhatriwalla A, Murdoch DJ, Hensey M, Lau K, Alkhodair A, Dvir D, Asgar AW, Cheung A, Blanke P, Ye J, Rieu R, Pibarot P, Wood D, Leipsic J, Webb JG. Valve-in-Valve Transcatheter Aortic Valve Replacement and Bioprosthetic Valve Fracture Comparing Different Transcatheter Heart Valve Designs: An Ex Vivo Bench Study. JACC Cardiovasc Interv 2019; 12:65-75. [PMID: 30621980 DOI: 10.1016/j.jcin.2018.10.043] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 10/04/2018] [Accepted: 10/23/2018] [Indexed: 11/16/2022]
Abstract
OBJECTIVES The authors assessed the effect of valve-in-valve (VIV) transcatheter aortic valve replacement (TAVR) followed by bioprosthetic valve fracture (BVF), testing different transcatheter heart valve (THV) designs in an ex vivo bench study. BACKGROUND Bioprosthetic valve fracture can be performed to improve residual transvalvular gradients following VIV TAVR. METHODS The authors evaluated VIV TAVR and BVF with the SAPIEN 3 (S3) (Edwards Lifesciences, Irvine, California) and ACURATE neo (Boston Scientific Corporation, Natick, Massachusetts) THVs. A 20-mm and 23-mm S3 were deployed in a 19-mm and 21-mm Mitroflow (Sorin Group USA, Arvada, Colorado), respectively. A small ACURATE neo was deployed in both sizes of Mitroflow tested. VIV TAVR samples underwent multimodality imaging, and hydrodynamic evaluation before and after BVF. RESULTS A high implantation was required to enable full expansion of the upper crown of the ACURATE neo and allow optimal leaflet function. Marked underexpansion of the lower crown of the THV within the surgical valve was also observed. Before BVF, VIV TAVR in the 19-mm Mitroflow had high transvalvular gradients using either THV design (22.0 mm Hg S3, and 19.1 mm Hg ACURATE neo). After BVF, gradients improved and were similar for both THVs (14.2 mm Hg S3, and 13.8 mm Hg ACURATE neo). The effective orifice area increased with BVF from 1.2 to 1.6 cm2 with the S3 and from 1.4 to 1.6 cm2 with the ACURATE neo. Before BVF, VIV TAVR with the ACURATE neo in the 21-mm Mitroflow had lower gradients compared with S3 (11.3 mm Hg vs. 16 mm Hg). However, after BVF valve gradients were similar for both THVs (8.4 mm Hg ACURATE neo vs. 7.8 mm Hg S3). The effective orifice area increased from 1.5 to 2.1 cm2 with the S3 and from 1.8 to 2.2 cm2 with the ACURATE neo. CONCLUSIONS BVF performed after VIV TAVR results in improved residual gradients. Following BVF, residual gradients were similar irrespective of THV design. Use of a small ACURATE neo for VIV TAVR in small (≤21 mm) surgical valves may be associated with challenges in achieving optimum THV position and expansion. BVF could be considered in selected clinical cases.
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Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Sellers
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Aaron M Barlow
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada
| | | | - Rob Fraser
- ViVitro Labs Inc., Victoria, British Columbia, Canada
| | | | - Keith B Allen
- Saint Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Adnan Chhatriwalla
- Saint Luke's Hospital, St. Luke's Mid America Heart Institute, Kansas City, Missouri
| | - Dale J Murdoch
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; University of Queensland, Brisbane, Australia
| | - Mark Hensey
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Karen Lau
- Centre for Heart Lung Innovation, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Abdullah Alkhodair
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Danny Dvir
- University of Washington, Seattle, Washington
| | | | - Anson Cheung
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - Jian Ye
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Régis Rieu
- Aix-Marseille Univ, IFSTTAR, LBA UMR_T24, Marseille, France
| | | | - David Wood
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Jonathan Leipsic
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, British Columbia, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada.
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Bidar E, Folliguet T, Kluin J, Muneretto C, Parolari A, Barili F, Suwalski P, Bonaros N, Punjabi P, Sadaba R, De Bonis M, Al-Attar N, Obadia JF, Czerny M, Shrestha M, Zegdi R, Natour E, Lorusso R. Postimplant biological aortic prosthesis degeneration: challenges in transcatheter valve implants. Eur J Cardiothorac Surg 2019; 55:191-200. [PMID: 30541101 DOI: 10.1093/ejcts/ezy391] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 10/15/2018] [Indexed: 12/29/2022] Open
Abstract
Surgical aortic valve replacement (SAVR) is highly effective and can be achieved with relatively low risk in patients with severe aortic stenosis. Bioprostheses have been used most frequently during the past 60 years. However, the function of biological valves usually declines after 10-15 years from implant when structural valve degeneration occurs often mandating a reoperation once valve dysfunction becomes haemodynamically significant. Known for many years by surgeons and cardiologists taking care of patients with SAVR, the issue of postimplant structural valve degeneration has been recently highlighted also in patients with transcatheter aortic valve implant (TAVI). There is growing concern that TAVI valves exhibit structural valve degeneration due to inherent challenges of the deployment mode. The impact on postimplant degeneration of TAVI valves compared to SAVR has still to be understood and defined. Based on the ongoing process of expanding TAVI indications, several potential shortcomings and caveats, learned during the last 60 years of SAVR experience, should be taken into consideration to refine this technique.
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Affiliation(s)
- Elham Bidar
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Thierry Folliguet
- Centre Hospitalo-Universitaire Brabois ILCV, Hôpital Henri Mondor, Division of Cardio Thoracic Surgery and Transplantation, Université Paris 12 UPEC, France
| | - Jolanda Kluin
- Department of Cardio-Thoracic Surgery, Academic Medical Center, Amsterdam, Netherlands
| | - Claudio Muneretto
- Cardiac Surgery Unit, University of Brescia Medical School, Brescia, Italy
| | - Alessandro Parolari
- Cardiac Surgery and Translational Research Units, IRCCS, Policlinico S. Donato, University of Milan, Milan, Italy
| | - Fabio Barili
- Department of Cardiac Surgery, S. Croce Hospital, Cuneo, Italy
| | - Piotr Suwalski
- Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, Warsaw, Poland
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Innsbruck Medical University, Innsbruck, Austria
| | - Prakash Punjabi
- Department of Cardio-Thoracic Surgery, Imperial College Healthcare NHS Trust, Imperial College School of Medicine, London, UK
| | - Rafa Sadaba
- Department of Cardiac Surgery, Hospital de Navarra, Pamplona, Spain
| | - Michele De Bonis
- Department of Cardiac Surgery, S. Raffaele University Hospital, Milan, Italy
| | - Nawwar Al-Attar
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK
| | - Jean Francois Obadia
- Department of Cardio-Thoracic Surgery, Hôpital Cardiothoracique Louis Pradel, Lyon, France
| | - Martin Czerny
- Department of Cardio-Vascular Surgery, University Hospital Freiburg, Freiburg, Germany
| | - Malakh Shrestha
- Department of Cardio-Thoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany
| | - Rachid Zegdi
- Hôpital Européen Georges Pompidou, Paris, France
| | - Ehsan Natour
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
| | - Roberto Lorusso
- Department of Cardio-Thoracic Surgery, Maastricht University Medical Centre, Maastricht, Netherlands
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Vrachatis DA, Vavuranakis M, Tsoukala S, Giotaki S, Papaioannou TG, Siasos G, Deftereos G, Giannopoulos G, Raisakis K, Tousoulis D, Deftereos S, Vavuranakis M. "TAVI: Valve in valve. A new field for structuralists? Literature review". Hellenic J Cardiol 2019; 61:148-153. [PMID: 31809790 DOI: 10.1016/j.hjc.2019.10.016] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2019] [Revised: 08/23/2019] [Accepted: 10/16/2019] [Indexed: 12/30/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) led to the foundation of the subspecialty of structural heart interventions and created an emerging area of clinical and technical issues. Soon after TAVI introduction into clinical practice, boundaries were expanded with utilization of valve-in-valve (V-i-V) techniques. V-i-V comprised a diverse subset of patients including TAVI within TAVI, TAVI within a degenerated surgically implanted bioprosthesis, or even TAVI-in-TAVI-in-surgical bioprosthesis. In the present review, we summarize the available literature and present initial experience on the field in Greece.
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Affiliation(s)
- Dimitrios A Vrachatis
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece.
| | - Michail Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
| | - Styliani Tsoukala
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece
| | - Sotiria Giotaki
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | | | - Gerasimos Siasos
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Gerasimos Deftereos
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece
| | - Georgios Giannopoulos
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece
| | - Konstantinos Raisakis
- Department of Cardiology, General Hospital of Athens, "G.Gennimatas", Athens, Greece
| | - Dimitrios Tousoulis
- 1st Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Spyridon Deftereos
- 2nd Department of Cardiology, National and Kapodistrian University of Athens, Greece
| | - Manolis Vavuranakis
- 3rd Department of Cardiology, National and Kapodistrian University of Athens, Athens, Greece
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Luraghi G, Migliavacca F, García-González A, Chiastra C, Rossi A, Cao D, Stefanini G, Rodriguez Matas JF. On the Modeling of Patient-Specific Transcatheter Aortic Valve Replacement: A Fluid-Structure Interaction Approach. Cardiovasc Eng Technol 2019; 10:437-455. [PMID: 31309527 DOI: 10.1007/s13239-019-00427-0] [Citation(s) in RCA: 51] [Impact Index Per Article: 10.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/04/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Transcatheter aortic valve replacement (TAVR) is a minimally invasive treatment for high-risk patients with aortic diseases. Despite its increasing use, many influential factors are still to be understood and require continuous investigation. The best numerical approach capable of reproducing both the valves mechanics and the hemodynamics is the fluid-structure interaction (FSI) modeling. The aim of this work is the development of a patient-specific FSI methodology able to model the implantation phase as well as the valve working conditions during cardiac cycles. METHODS The patient-specific domain, which included the aortic root, native valve and calcifications, was reconstructed from CT images, while the CAD model of the device, metallic frame and pericardium, was drawn from literature data. Ventricular and aortic pressure waveforms, derived from the patient's data, were used as boundary conditions. The proposed method was applied to two real clinical cases, which presented different outcomes in terms of paravalvular leakage (PVL), the main complication after TAVR. RESULTS The results confirmed the clinical prognosis of mild and moderate PVL with coherent values of regurgitant volume and effective regurgitant orifice area. Moreover, the final release configuration of the device and the velocity field were compared with postoperative CT scans and Doppler traces showing a good qualitative and quantitative matching. CONCLUSION In conclusion, the development of realistic and accurate FSI patient-specific models can be used as a support for clinical decisions before the implantation.
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Affiliation(s)
- Giulia Luraghi
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Piazza L. da Vinci 32, 20133, Milan, Italy.
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Alberto García-González
- Laboratori de Càlcul Numèric (LaCàN), E.T.S. de Ingenieros de Caminos, Canales y Puertos, Universitat Politècnica de Catalunya (UPC), Jordi Girona 1-3, 08034, Barcelona, Spain
| | - Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Piazza L. da Vinci 32, 20133, Milan, Italy.,PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Davide Cao
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Jose Felix Rodriguez Matas
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Piazza L. da Vinci 32, 20133, Milan, Italy
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Xiong TY, Li YJ, Feng Y, Liao YB, Zhao ZG, Mylotte D, Wei X, Xu YN, Peng Y, Wei JF, Zheng MX, Zhou X, Meng W, Piazza N, Chen M. Understanding the Interaction Between Transcatheter Aortic Valve Prostheses and Supra-Annular Structures From Post-Implant Stent Geometry. JACC Cardiovasc Interv 2019; 12:1164-1171. [DOI: 10.1016/j.jcin.2019.02.051] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2018] [Revised: 02/11/2019] [Accepted: 02/14/2019] [Indexed: 11/29/2022]
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38
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Sathananthan J, Sellers SL, Fraser R, Dvir D, Hensey M, Murdoch DJ, Blanke P, Pibarot P, Toggweiler S, Wood D, Leipsic J, Webb JG. Impact of implant depth on hydrodynamic function with the ACURATE neo transcatheter heart valve following valve-in-valve transcatheter aortic valve replacement in Mitroflow bioprosthetic valves: an ex vivo bench study. EUROINTERVENTION 2019; 15:78-87. [DOI: 10.4244/eij-d-18-00947] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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39
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Dasi LP, Grande-Allen J, Kunzelman K, Kuhl E. The Pursuit of Engineering the Ideal Heart Valve Replacement or Repair: A Special Issue of the Annals of Biomedical Engineering. Ann Biomed Eng 2018; 45:307-309. [PMID: 28150054 DOI: 10.1007/s10439-017-1801-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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40
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Rotman OM, Bianchi M, Ghosh RP, Kovarovic B, Bluestein D. Principles of TAVR valve design, modelling, and testing. Expert Rev Med Devices 2018; 15:771-791. [PMID: 30318937 PMCID: PMC6417919 DOI: 10.1080/17434440.2018.1536427] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has emerged as an effective minimally-invasive alternative to surgical valve replacement in medium- to high-risk, elderly patients with calcific aortic valve disease and severe aortic stenosis. The rapid growth of the TAVR devices market has led to a high variety of designs, each aiming to address persistent complications associated with TAVR valves that may hamper the anticipated expansion of TAVR utility. AREAS COVERED Here we outline the challenges and the technical demands that TAVR devices need to address for achieving the desired expansion, and review design aspects of selected, latest generation, TAVR valves of both clinically-used and investigational devices. We further review in detail some of the up-to-date modeling and testing approaches for TAVR, both computationally and experimentally, and additionally discuss those as complementary approaches to the ISO 5840-3 standard. A comprehensive survey of the prior and up-to-date literature was conducted to cover the most pertaining issues and challenges that TAVR technology faces. EXPERT COMMENTARY The expansion of TAVR over SAVR and to new indications seems more promising than ever. With new challenges to come, new TAV design approaches, and materials used, are expected to emerge, and novel testing/modeling methods to be developed.
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Affiliation(s)
- Oren M. Rotman
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Matteo Bianchi
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Ram P. Ghosh
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
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41
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Krishnaswamy A, Kapadia SR. Optimizing Valve Sizing in Balloon-Expandable Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2018; 11:1706-1709. [PMID: 30190061 DOI: 10.1016/j.jcin.2018.07.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 07/16/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Amar Krishnaswamy
- Division of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio.
| | - Samir R Kapadia
- Division of Interventional Cardiology, Department of Cardiovascular Medicine, Heart and Vascular Institute, Cleveland Clinic, Cleveland, Ohio
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42
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Rotman OM, Kovarovic B, Chiu WC, Bianchi M, Marom G, Slepian MJ, Bluestein D. Novel Polymeric Valve for Transcatheter Aortic Valve Replacement Applications: In Vitro Hemodynamic Study. Ann Biomed Eng 2018; 47:113-125. [PMID: 30194551 DOI: 10.1007/s10439-018-02119-7] [Citation(s) in RCA: 38] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/17/2018] [Indexed: 11/30/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is a minimally-invasive approach for treating severe aortic stenosis. All clinically-used TAVR valves to date utilize chemically-fixed xenograft as the leaflet material. Inherent limitation of the tissue (e.g., calcific degeneration) motivates the search for alternative leaflet material. Here we introduce a novel polymeric TAVR valve that was designed to address the limitations of tissue-valves. In this study, we experimentally evaluated the hemodynamic performance of the valve and compared its performance to clinically-used valves: a gold standard surgical tissue valve, and a TAVR valve. Our comparative testing protocols included: (i) baseline hydrodynamics (ISO:5840-3), (ii) complementary patient-specific hydrodynamics in a dedicated system, and (iii) thrombogenicity. The patient-specific testing system facilitated comparing TAVR valves performance under more realistic conditions. Baseline hydrodynamics results at CO 4-7 L/min showed superior effective orifice area (EOA) for the polymer valve, most-notably as compared to the reference TAVR valve. Regurgitation fraction was higher in the polymeric valve, but within the ISO minimum requirements. Thrombogenicity trends followed the EOA results with the polymeric valve being the least thrombogenic, and clinical TAVR being the most. Hemodynamic-wise, the results strongly indicate that our polymeric TAVR valve can outperform tissue valves.
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Affiliation(s)
- Oren M Rotman
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA
| | - Wei-Che Chiu
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA
| | - Matteo Bianchi
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA
| | - Gil Marom
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA.,School of Mechanical Engineering, Tel Aviv University, 6997801, Tel Aviv, Israel
| | - Marvin J Slepian
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, 85721, USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8151, USA.
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43
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Study on the Accuracy of Structural and FSI Heart Valves Simulations. Cardiovasc Eng Technol 2018; 9:723-738. [DOI: 10.1007/s13239-018-00373-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 08/11/2018] [Indexed: 12/29/2022]
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44
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Webb JG, Murdoch D, Dvir D. Will Transcatheter Replacement Become the New Default Therapy When Bioprosthetic Valves Fail? J Am Coll Cardiol 2018; 72:383-385. [DOI: 10.1016/j.jacc.2018.04.073] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 04/10/2018] [Indexed: 10/28/2022]
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45
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Bove T. The choice of heart valve prosthesis for aortic valve replacement in the young: about choices and consequences. ANNALS OF TRANSLATIONAL MEDICINE 2018; 6:184. [PMID: 29951506 DOI: 10.21037/atm.2018.02.22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Affiliation(s)
- Thierry Bove
- Department of Cardiac Surgery, University Hospital Gent, Gent, Belgium
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46
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Ghosh R, Marom G, Rotman O, Slepian MJ, Prabhakar S, Horner M, Bluestein D. Comparative Fluid-Structure Interaction Analysis of Polymeric Transcatheter and Surgical Aortic Valves' Hemodynamics and Structural Mechanics. J Biomech Eng 2018; 140:2686528. [PMID: 30029207 DOI: 10.1115/1.4040600] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2017] [Indexed: 02/28/2024]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as an effective alternative to conventional surgical aortic valve replacement (SAVR) in high-risk elderly patients with calcified aortic valve disease. All currently FDA-approved TAVR devices use tissue valves that were adapted to but not specifically designed for TAVR use. Emerging clinical evidence indicates that these valves may get damaged during crimping and deployment- leading to valvular calcification, thrombotic complications, and limited durability. This impedes the expected expansion of TAVR to lower-risk and younger patients. Viable polymeric valves have the potential to overcome such limitations. We have developed a polymeric SAVR valve, which was optimized to reduce leaflet stresses and offer a thromboresistance profile similar to that of a tissue valve. This study compares the polymeric SAVR valve's hemodynamic performance and mechanical stresses to a new version of the valve- specifically designed for TAVR. Fluid-structure interaction (FSI) models were utilized and the valves' hemodynamics, flexural stresses, strains, orifice area, and wall shear stresses were compared. The TAVR valve had 42% larger opening area and 27% higher flow rate versus the SAVR valve, while wall shear stress distribution and mechanical stress magnitudes were of the same order, demonstrating the enhanced performance of the TAVR valve prototype. The TAVR valve FSI simulation and Vivitro pulse duplicator experiments were compared in terms of the leaflets' kinematics and the effective orifice area. The numerical methodology presented can be further used as a predictive tool for valve design optimization for enhanced hemodynamics and durability.
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Affiliation(s)
- Ram Ghosh
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-8151, USA
| | - Gil Marom
- School of Mechanical Engineering, Faculty of Engineering, Tel Aviv University, Tel Aviv 6997801, Israel; Biomedical Engineering Department, Stony Brook University, Stony Brook 11794, NY, USA
| | - Oren Rotman
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-8151, USA
| | - Marvin J Slepian
- Department of Biomedical Engineering and Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ 85724, USA
| | - Saurabh Prabhakar
- ANSYS Fluent India Pvt Ltd., MIDC, Plot No. 34/1, Rajiv Gandhi IT Park, Hinjewadi, Pune 411057, India
| | - Marc Horner
- ANSYS, Inc., 1007 Church St, Suite 250, Evanston, IL 60201, USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794-8151, USA
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47
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Zenses AS, Evin MA, Stanová V, Clavel MA, Barragan P, Rodés-Cabau J, Obadia JF, Pibarot P, Rieu R. Effect of size and position of self-expanding transcatheter valve on haemodynamics following valve-in-valve procedure in small surgical bioprostheses: an in vitro study. EUROINTERVENTION 2018. [DOI: 10.4244/eij-d-17-00875] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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48
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Transcaval Valve-in-Valve-in-Valve Aortic Valve Replacement for Bioprosthetic Valve Degeneration. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018; 13:132-135. [PMID: 29668501 DOI: 10.1097/imi.0000000000000477] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
A 74-year-old man presented with progressive dyspnea on exertion. History included peripheral arterial disease and coronary artery bypass grafting with aortic valve replacement 12 years ago. Subsequently, the surgical valve developed severe stenosis and moderate insufficiency. He underwent a transapical valve-in-valve transcatheter aortic valve replacement 5 years before presentation. This second valve developed a mean gradient of 66 mm Hg with mild insufficiency. The patient was treated with a third aortic valve using an alternative transcaval approach, significantly alleviating his symptoms.
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49
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Watkins AC, Devireddy CM, Al-Atassi T, Simone AE, Forcillo J, Thourani VH. Transcaval Valve-in-Valve-in-Valve Aortic Valve Replacement for Bioprosthetic Valve Degeneration. INNOVATIONS-TECHNOLOGY AND TECHNIQUES IN CARDIOTHORACIC AND VASCULAR SURGERY 2018. [DOI: 10.1177/155698451801300210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- A. Claire Watkins
- Department of Cardiothoracic Surgery, Stanford University School of Medicine, Stanford, CA USA
| | - Chandan M. Devireddy
- Division of Cardiology, Structural Heart and Valve Center, Emory University, Atlanta, GA USA
| | - Talal Al-Atassi
- Division of Cardiac Surgery, University of Ottawa Heart Institute, Ottawa, ON Canada
| | - Amy E. Simone
- Piedmont Healthcare, Marcus Heart Valve Center, Atlanta, GA USA
| | - Jessica Forcillo
- Department of Cardiac Surgery, Universitέ de Montrέal, Montrέal, PQ Canada
| | - Vinod H. Thourani
- Medstar Heart and Vascular Institute, Washington Hospital Center, Washington, DC USA
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50
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Murdock K, Martin C, Sun W. Characterization of mechanical properties of pericardium tissue using planar biaxial tension and flexural deformation. J Mech Behav Biomed Mater 2017; 77:148-156. [PMID: 28915471 DOI: 10.1016/j.jmbbm.2017.08.039] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2017] [Revised: 08/21/2017] [Accepted: 08/25/2017] [Indexed: 11/26/2022]
Abstract
Flexure is an important mode of deformation for native and bioprosthetic heart valves. However, mechanical characterization of bioprosthetic leaflet materials has been done primarily through planar tensile testing. In this study, an integrated experimental and computational cantilever beam bending test was performed to characterize the flexural properties of glutaraldehyde-treated bovine and porcine pericardium of different thicknesses. A strain-invariant based structural constitutive model was used to model the pericardial mechanical behavior quantified through the bending tests of this study and the planar biaxial tests previously performed. The model parameters were optimized through an inverse finite element (FE) procedure in order to describe both sets of experimental data. The optimized material properties were implemented in FE simulations of transcatheter aortic valve (TAV) deformation. It was observed that porcine pericardium TAV leaflets experienced significantly more flexure than bovine when subjected to opening pressurization, and that the flexure may be overestimated using a constitutive model derived from purely planar tensile experimental data. Thus, modeling of a combination of flexural and biaxial tensile testing data may be necessary to more accurately describe the mechanical properties of pericardium, and to computationally investigate bioprosthetic leaflet function and design.
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Affiliation(s)
- Kyle Murdock
- Tissue Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Caitlin Martin
- Tissue Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States
| | - Wei Sun
- Tissue Mechanics Laboratory, Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, United States.
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