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Mutlu O, Saribay M, Yavuz MM, Salman HE, Al-Nabti ARDMH, Yalcin HC. Material modeling and recent findings in transcatheter aortic valve implantation simulations. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 255:108314. [PMID: 39024970 DOI: 10.1016/j.cmpb.2024.108314] [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: 03/11/2024] [Revised: 06/12/2024] [Accepted: 06/28/2024] [Indexed: 07/20/2024]
Abstract
BACKGROUND AND OBJECTIVE Transcatheter aortic valve implantation (TAVI) has significantly transformed the management of aortic valve (AV) diseases, presenting a minimally invasive option compared to traditional surgical valve replacement. Computational simulations of TAVI become more popular and offer a detailed investigation by employing patient-specific models. On the other hand, employing accurate material modeling procedures and applying basic modeling steps are crucial to determining reliable numerical results. Therefore, this review aims to outline the basic modeling approaches for TAVI, focusing on material modeling and geometry extraction, as well as summarizing the important findings from recent computational studies to guide future research in the field. METHODS This paper explains the basic steps and important points in setting up and running TAVI simulations. The material properties of the leaflets, valves, stents, and tissues utilized in TAVI simulations are provided, along with a comprehensive explanation of the geometric extraction methods employed. The differences between the finite element analysis, computational fluid dynamics, and fluid-structure interaction approaches are pointed out and the important aspects of TAVI modeling are described by elucidating the recent computational studies. RESULTS The results of the recent findings on TAVI simulations are summarized to demonstrate its powerful potential. It is observed that the material properties of aortic tissues and components of implanted valves should be modeled realistically to determine accurate results. For patient-specific AV geometries, incorporating calcific deposits on the leaflets is essential for ensuring the accuracy of computational findings. The results of numerical TAVI simulations indicate the significance of the selection of optimal valves and precise deployment within the appropriate anatomical position. These factors collectively contribute to the effective functionality of the implanted valve. CONCLUSIONS Recent studies in the literature have revealed the critical importance of patient-specific modeling, the selection of accurate material models, and bio-prosthetic valve diameters. Additionally, these studies emphasize the necessity of precise positioning of bio-prosthetic valves to achieve optimal performance in TAVI, characterized by an increased effective orifice area and minimal paravalvular leakage.
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Affiliation(s)
- Onur Mutlu
- Qatar University, Biomedical Research Center, Doha, Qatar
| | - Murat Saribay
- Istanbul Bilgi University, Mechanical Engineering Department, Istanbul, Turkey
| | - Mehmet Metin Yavuz
- Middle East Technical University, Mechanical Engineering Department, Ankara, Turkey
| | - Huseyin Enes Salman
- TOBB University of Economics and Technology, Department of Mechanical Engineering, Ankara, Turkey
| | | | - Huseyin Cagatay Yalcin
- Qatar University, Biomedical Research Center, Doha, Qatar; Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha, Qatar.
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Pak DH, Liu M, Kim T, Ozturk C, McKay R, Roche ET, Gleason R, Duncan JS. Robust automated calcification meshing for personalized cardiovascular biomechanics. NPJ Digit Med 2024; 7:213. [PMID: 39143242 PMCID: PMC11324740 DOI: 10.1038/s41746-024-01202-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 07/26/2024] [Indexed: 08/16/2024] Open
Abstract
Calcification has significant influence over cardiovascular diseases and interventions. Detailed characterization of calcification is thus desired for predictive modeling, but calcium deposits on cardiovascular structures are still often manually reconstructed for physics-driven simulations. This poses a major bottleneck for large-scale adoption of computational simulations for research or clinical use. To address this, we propose an end-to-end automated image-to-mesh algorithm that enables robust incorporation of patient-specific calcification onto a given cardiovascular tissue mesh. The algorithm provides a substantial speed-up from several hours of manual meshing to ~1 min of automated computation, and it solves an important problem that cannot be addressed with recent template-based meshing techniques. We validated our final calcified tissue meshes with extensive simulations, demonstrating our ability to accurately model patient-specific aortic stenosis and Transcatheter Aortic Valve Replacement. Our method may serve as an important tool for accelerating the development and usage of personalized cardiovascular biomechanics.
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Affiliation(s)
- Daniel H Pak
- Yale University, 300 Cedar St, New Haven, CT, 06511, USA.
| | - Minliang Liu
- Texas Tech University, 805 Boston Avenue, Lubbock, TX, 79409, USA
| | - Theodore Kim
- Yale University, 300 Cedar St, New Haven, CT, 06511, USA
| | - Caglar Ozturk
- Massachusetts Institute of Technology, 45 Carleton St, Cambridge, MA, 02142, USA
- University of Southampton, University Road, Southampton, SO17 1BJ, UK
| | - Raymond McKay
- Hartford Hospital, 85 Seymour St, Hartford, CT, 06106, USA
| | - Ellen T Roche
- Massachusetts Institute of Technology, 45 Carleton St, Cambridge, MA, 02142, USA
| | - Rudolph Gleason
- Georgia Institute of Technology, 315 Ferst Dr NW, Atlanta, GA, 30332, USA
| | - James S Duncan
- Yale University, 300 Cedar St, New Haven, CT, 06511, USA
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Meng Z, Zhang H, Cai Y, Gao Y, Liang C, Wang J, Chen X, Guo L, Wang S. Computational study of transcatheter aortic valve replacement based on patient-specific models-rapid surgical planning for self-expanding valves. Front Physiol 2024; 15:1407215. [PMID: 38903911 PMCID: PMC11187333 DOI: 10.3389/fphys.2024.1407215] [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: 03/26/2024] [Accepted: 05/15/2024] [Indexed: 06/22/2024] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a minimally invasive interventional solution for treating aortic stenosis. The complex post-TAVR complications are associated with the type of valve implanted and the position of the implantation. The study aimed to establish a rapid numerical research method for TAVR to assess the performance differences of self-expanding valves released at various positions. It also aimed to calculate the risks of postoperative paravalvular leak and atrioventricular conduction block, comparing these risks to clinical outcomes to verify the method's effectiveness and accuracy. Based on medical images, six cases were established, including the aortic wall, native valve and calcification; one with a bicuspid aortic valve and five with tricuspid aortic valves. The parameters for the stent materials used by the patients were customized. High strain in the contact area between the stent and the valve annulus may lead to atrioventricular conduction block. Postoperatively, the self-expanding valve maintained a circular cross-section, reducing the risk of paravalvular leak and demonstrating favorable hemodynamic characteristics, consistent with clinical observations. The outcomes of the six simulations showed no significant difference in valve frame morphology or paravalvular leak risk compared to clinical results, thereby validating the numerical simulation process proposed for quickly selecting valve models and optimal release positions, aiding in TAVR preoperative planning based on patients'geometric characteristics.
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Affiliation(s)
- Zhuangyuan Meng
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Haishan Zhang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Yunhan Cai
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Yuan Gao
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Changbin Liang
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - Jun Wang
- Department of Anesthesia, First Hospital of China Medical University, Shenyang, China
| | - Xin Chen
- Department of Cardiovascular Ultrasound, First Hospital of China Medical University, Shenyang, China
| | - Liang Guo
- Department of Cardiology, First Hospital of China Medical University, Shenyang, China
| | - ShengZhang Wang
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
- Academy for Engineering and Technology, Institute of Biomedical Engineering Technology, Fudan University, Shanghai, China
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4
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Shen X, Xu Y, Li H, Wang L, Sun P, Liu Q, Chen J, He Z. Mechanical behaviors of a new elliptical valve stent in bicuspid aortic valve. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2024; 250:108173. [PMID: 38615386 DOI: 10.1016/j.cmpb.2024.108173] [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: 01/18/2024] [Revised: 03/05/2024] [Accepted: 04/10/2024] [Indexed: 04/16/2024]
Abstract
BACKGROUND AND OBJECTIVE The conventional valve stents that are cylindrical in shape will become elliptical when implanted in bicuspid aortic valve, thereby reducing the durability of the artificial valve. In this study, a new design of valve stent is presented where valve stents have elliptical cross-section at the annulus and it is expected to have better expandability and circle shape during the interaction between the stent and bicuspid aortic valve, thereby extending the durability of artificial valve. METHODS Finite element method (FEM) is used to study the mechanical behavior of the novel valve stent in the bicuspid aortic valve. The effects of three matching relationship between the ellipticity of the stents and the ellipticity of the annulus (i.e., the ellipticity of the stent is greater than, equal to and less than the annulus ellipticity, respectively) on the mechanical behavior of stent expansion are studied. In addition, the expansion mechanical behavior of the novel valve stent at different implantation depths is also compared. RESULTS Results indicate that novel valve stent implantation with elliptical features is superior to conventional circular valve stent. When the novel valve stent ellipticity is less than the annulus ellipticity, the ellipticity of the novel valve stent after implantation is smaller than that of the conventional circular valve stent. This indicated that the novel valve stent has better expandability and post-expansion shape, making artificial valve to have better durability. The risk of paravalvular leak after implantation is lowest when the novel valve stent ellipticity is less than annulus ellipticity. When the novel valve stent ellipticity coincides with annulus ellipticity, the aortic wall is subjected to greatest stress. With the increase of implantation depth, the stress on the novel valve stent decrease. CONCLUSIONS This study might provide insights for improving stent design for bicuspid aortic valve.
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Affiliation(s)
| | - Yue Xu
- Jiangsu University, China
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Li J, Meng Z, Yan W, Wang W, Wei L, Wang S. Computational study of the balloon dilation steps on transcatheter aortic valve replacement. Front Bioeng Biotechnol 2023; 11:1333138. [PMID: 38179134 PMCID: PMC10765527 DOI: 10.3389/fbioe.2023.1333138] [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: 11/04/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Balloon dilation is a commonly used assistant method in transcatheter aortic valve replacement (TAVR) and plays an important role during valve implantation procedure. The balloon dilation steps need to be fully considered in TAVR numerical simulations. This study aims to establish a TAVR simulation procedure with two different balloon dilation steps to analyze the impact of balloon dilation on the results of TAVR implantation. Two cases of aortic stenosis were constructed based on medical images. An implantation simulation procedure with self-expandable valve was established, and multiple models including different simulation steps such as balloon pre-dilation and balloon post-dilation were constructed to compare the different effects on vascular stress, stent morphology and paravalvular leakage. Results show that balloon pre-dilation of TAVR makes less impact on post-operative outcomes, while post-dilation can effectively improve the implantation morphology of the stent, which is beneficial to the function and durability of the valve. It can effectively improve the adhesion of the stent and reduce the paravalvular leakage volume more than 30% after implantation. However, balloon post-dilation may also lead to about 20% or more increased stress on the aorta and increase the risk of damage. The balloon dilation makes an important impact on the TAVR outcomes. Balloon dilation needs to be fully considered during pre-operative analysis to obtain a better clinical result.
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Affiliation(s)
- Jianming Li
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Zhuangyuan Meng
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Wentao Yan
- Shanghai Inspection and Research Institute for Medical Devices, Shanghai, China
| | - Wenshuo Wang
- Department of Cardiac Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lai Wei
- Department of Cardiac Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Shengzhang Wang
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
- Academy for Engineering and Technology, Institute of Biomedical Engineering Technology, Fudan University, Shanghai, China
- Zhuhai Fudan Innovation Institute, Zhuhai, China
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Rouhollahi A, Willi JN, Haltmeier S, Mehrtash A, Straughan R, Javadikasgari H, Brown J, Itoh A, de la Cruz KI, Aikawa E, Edelman ER, Nezami FR. CardioVision: A fully automated deep learning package for medical image segmentation and reconstruction generating digital twins for patients with aortic stenosis. Comput Med Imaging Graph 2023; 109:102289. [PMID: 37633032 PMCID: PMC10599298 DOI: 10.1016/j.compmedimag.2023.102289] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/11/2023] [Accepted: 08/12/2023] [Indexed: 08/28/2023]
Abstract
Aortic stenosis (AS) is the most prevalent heart valve disease in western countries that poses a significant public health challenge due to the lack of a medical treatment to prevent valve calcification. Given the aging population demographic, the prevalence of AS is projected to rise, resulting in a progressively significant healthcare and economic burden. While surgical aortic valve replacement (SAVR) has been the gold standard approach, the less invasive transcatheter aortic valve replacement (TAVR) is poised to become the dominant method for high- and medium-risk interventions. Computational simulations using patient-specific models, have opened new research avenues for optimizing emerging devices and predicting clinical outcomes. The traditional techniques of generating digital replicas of patients' aortic root, native valve, and calcification are time-consuming and labor-intensive processes requiring specialized tools and expertise in anatomy. Alternatively, deep learning models, such as the U-Net architecture, have emerged as reliable and fully automated methods for medical image segmentation. Two-dimensional U-Nets have been shown to produce comparable or more accurate results than trained clinicians' manual segmentation while significantly reducing computational costs. In this study, we have developed a fully automatic AI tool capable of reconstructing the digital twin geometry and analyzing the calcification distribution on the aortic valve. The developed automatic segmentation package enables the modeling of patient-specific anatomies, which can then be used to simulate virtual interventional procedures, optimize emerging prosthetic devices, and predict clinical outcomes.
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Affiliation(s)
- Amir Rouhollahi
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - James Noel Willi
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Sandra Haltmeier
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Alireza Mehrtash
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Ross Straughan
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Department of Mechanical and Process Engineering, ETH Zurich, Zurich, Switzerland
| | - Hoda Javadikasgari
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Jonathan Brown
- Clinical and Translation Science Institute, Tufts University, Boston, MA, USA; Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA
| | - Akinobu Itoh
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Kim I de la Cruz
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elena Aikawa
- Center for Interdisciplinary Cardiovascular Sciences, Division of Cardiovascular Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA; Center for Excellence in Vascular Biology, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Elazer R Edelman
- Institute for Medical Engineering and Science, Massachusetts Institute of Technology, Cambridge, MA, USA; Cardiovascular Division, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA
| | - Farhad R Nezami
- Division of Cardiac Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA, USA.
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Abdelkhalek M, Bahadormanesh N, Ganame J, Keshavarz-Motamed Z. Incremental prognostic value of intensity-weighted regional calcification scoring using contrast CT imaging in TAVR. EUROPEAN HEART JOURNAL. IMAGING METHODS AND PRACTICE 2023; 1:qyad027. [PMID: 39045072 PMCID: PMC11195730 DOI: 10.1093/ehjimp/qyad027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 09/11/2023] [Indexed: 07/25/2024]
Abstract
Aims Aortic valve calcification scoring plays an important role in predicting outcomes of transcatheter aortic valve replacement (TAVR). However, the impact of relative calcific density and its causal effect on peri-procedural complications due to sub-optimal valve expansion remains limited. This study aims to investigate the prognostic power of quantifying regional calcification in the device landing zone in the context of peri-procedural events and post-procedural complications based on pre-operative contrast computed tomography angiography (CCTA) images. Assess the effect of calcification on post-procedural device expansion and final configuration. Methods and results We introduce a novel patient invariant topographic scheme for quantifying the location and relative density of landing zone calcification. The calcification was detected on CCTA images based on a recently developed method using automatic minimization of the false positive rate between aortic lumen and calcific segments. Multinomial logistic regression model evaluation and ROC curve analysis showed excellent classification power for predicting paravalvular leakage [area under the curve (AUC) = 0.8; P < 0.001] and balloon pre-dilation (AUC = 0.907; P < 0.001). The model exhibited an acceptable classification ability for left bundle branch block (AUC = 0.748; P < 0.001) and balloon post-dilation (AUC = 0.75; P < 0.001). Notably, all evaluated models were significantly superior to alternative models that did not include intensity-weighted regional volume scoring. Conclusions TAVR planning based on contrast computed tomography images can benefit from detailed location, quantity, and density contribution of calcific deposits in the device landing zone. Those parameters could be employed to stratify patients who need a more personalized approach during TAVR planning, predict peri-procedural complications, and indicate patients for follow-up monitoring.
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Affiliation(s)
- Mohamed Abdelkhalek
- School of Biomedical Engineering, McMaster University, 1280 Main St W, Hamilton, ON L8S4L8, Canada
| | - Nikrouz Bahadormanesh
- Department of Mechanical Engineering, McMaster University, 1280 Main St W, Hamilton, ON L8S4L8, Canada
| | - Javier Ganame
- Department of Medicine, McMaster University, Hamilton, 1280 Main St W, Hamilton, ON L8S4L8, Canada
| | - Zahra Keshavarz-Motamed
- School of Biomedical Engineering, McMaster University, 1280 Main St W, Hamilton, ON L8S4L8, Canada
- Department of Mechanical Engineering, McMaster University, 1280 Main St W, Hamilton, ON L8S4L8, Canada
- School of Computational Science and Engineering, McMaster University, 1280 Main St W, Hamilton, ON L8S4L8, Canada
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Tahir AM, Mutlu O, Bensaali F, Ward R, Ghareeb AN, Helmy SMHA, Othman KT, Al-Hashemi MA, Abujalala S, Chowdhury MEH, Alnabti ARDMH, Yalcin HC. Latest Developments in Adapting Deep Learning for Assessing TAVR Procedures and Outcomes. J Clin Med 2023; 12:4774. [PMID: 37510889 PMCID: PMC10381346 DOI: 10.3390/jcm12144774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 04/08/2023] [Accepted: 04/10/2023] [Indexed: 07/30/2023] Open
Abstract
Aortic valve defects are among the most prevalent clinical conditions. A severely damaged or non-functioning aortic valve is commonly replaced with a bioprosthetic heart valve (BHV) via the transcatheter aortic valve replacement (TAVR) procedure. Accurate pre-operative planning is crucial for a successful TAVR outcome. Assessment of computational fluid dynamics (CFD), finite element analysis (FEA), and fluid-solid interaction (FSI) analysis offer a solution that has been increasingly utilized to evaluate BHV mechanics and dynamics. However, the high computational costs and the complex operation of computational modeling hinder its application. Recent advancements in the deep learning (DL) domain can offer a real-time surrogate that can render hemodynamic parameters in a few seconds, thus guiding clinicians to select the optimal treatment option. Herein, we provide a comprehensive review of classical computational modeling approaches, medical imaging, and DL approaches for planning and outcome assessment of TAVR. Particularly, we focus on DL approaches in previous studies, highlighting the utilized datasets, deployed DL models, and achieved results. We emphasize the critical challenges and recommend several future directions for innovative researchers to tackle. Finally, an end-to-end smart DL framework is outlined for real-time assessment and recommendation of the best BHV design for TAVR. Ultimately, deploying such a framework in future studies will support clinicians in minimizing risks during TAVR therapy planning and will help in improving patient care.
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Affiliation(s)
- Anas M Tahir
- Electrical and Computer Engineering Department, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
| | - Onur Mutlu
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
| | - Faycal Bensaali
- Department of Electrical Engineering, Qatar University, Doha 2713, Qatar
| | - Rabab Ward
- Electrical and Computer Engineering Department, The University of British Columbia, Vancouver, BC V6T 1Z4, Canada
| | - Abdel Naser Ghareeb
- Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
- Faculty of Medicine, Al Azhar University, Cairo 11884, Egypt
| | - Sherif M H A Helmy
- Noninvasive Cardiology Section, Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
| | | | - Mohammed A Al-Hashemi
- Noninvasive Cardiology Section, Cardiology Department, Heart Hospital, Hamad Medical Corporation, Doha 3050, Qatar
| | | | | | | | - Huseyin C Yalcin
- Biomedical Research Center, Qatar University, Doha 2713, Qatar
- Department of Biomedical Science, College of Health Sciences, QU Health, Qatar University, Doha 2713, Qatar
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9
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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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10
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Carbonaro D, Zambon S, Corti A, Gallo D, Morbiducci U, Audenino AL, Chiastra C. Impact of nickel-titanium super-elastic material properties on the mechanical performance of self-expandable transcatheter aortic valves. J Mech Behav Biomed Mater 2023; 138:105623. [PMID: 36535095 DOI: 10.1016/j.jmbbm.2022.105623] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 12/14/2022]
Abstract
Self-expandable transcatheter aortic valves (TAVs) elastically resume their initial shape when implanted without the need for balloon inflation by virtue of the nickel-titanium (NiTi) frame super-elastic properties. Experimental findings suggest that NiTi mechanical properties can vary markedly because of a strong dependence on the chemical composition and processing operations. In this context, this study presents a computational framework to investigate the impact of the NiTi super-elastic material properties on the TAV mechanical performance. Finite element (FE) analyses of TAV implantation were performed considering two different TAV frames and three idealized aortic root anatomies, evaluating the device mechanical response in terms of pullout force magnitude exerted by the TAV frame and peak maximum principal stress within the aortic root. The widely adopted NiTi constitute model by Auricchio and Taylor (1997) was used. A multi-parametric sensitivity analysis and a multi-objective optimization of the TAV mechanical performance were conducted in relation to the parameters of the NiTi constitutive model. The results highlighted that: five NiTi material model parameters (EA, σtLS, σtUS, σtUE and σcLS) are significantly correlated with the FE outputs; the TAV frame geometry and aortic root anatomy have a marginal effect on the level of influence of each NiTi material parameter; NiTi alloy candidates with pareto-optimal characteristics in terms of TAV mechanical performance can be successfully identified. In conclusion, the proposed computational framework supports the TAV design phase, providing information on the relationship between the super-elastic behavior of the supplied NiTi alloys and the device mechanical response.
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Affiliation(s)
- Dario Carbonaro
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Sara Zambon
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Anna Corti
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Diego Gallo
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Alberto L Audenino
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Claudio Chiastra
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
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Santos-Martínez S, Redondo A, González-Bartol E, Barrero A, Sánchez-Luna JP, Revilla-Orodea A, Baladrón C, Serrador A, San Román JA, Amat-Santos IJ. Feasibility of precise commissural and coronary alignment with balloon-expandable TAVI. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2023; 76:19-24. [PMID: 35570121 DOI: 10.1016/j.rec.2022.03.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 03/07/2022] [Indexed: 12/24/2022]
Abstract
INTRODUCTION AND OBJECTIVES We aimed to describe the feasibility and preliminary outcomes of commissural alignment (CA) for the balloon-expandable transcatheter heart valve. METHODS The relationship among native commissures and transcatheter aortic valve implantation neocommissures was analyzed in 10 consecutive patients with tricuspid severe aortic stenosis undergoing transcatheter aortic valve implantation after guided implantation based on computed tomography analysis with a self-developed software. CA was predicted by in silico bio-modelling in the 10 patients and the calculated rotation was applied during crimping. Degrees of CA and coronary overlap (CO) were measured through 1-month follow up computed tomography. Transvalvular residual gradients and the rate of paravalvular leak were also analyzed. RESULTS Mean commissural misalignment was 16.7±8°. Four patients showed mild misalignment but none of them showed a moderate or severe degree of misalignment. The in silico model accurately predicted the final in vivo position with a correlation coefficient of 0.983 (95%CI, 0.966-0.992), P <.001. Severe CO with right coronary ostium occurred in 3 patients likely due to ostial eccentricity, and CO was not present with the left coronary artery in any of the patients. Mean transaortic gradient was 6.1±3.3mmHg and there were no moderate-severe paravalvular leaks. CONCLUSIONS Patient-specific rotation during valve crimping based on preprocedural computed tomography is feasible with balloon-expandable devices and is associated with the absence of moderate or severe commissural misalignment and left main CO.
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Affiliation(s)
- Sandra Santos-Martínez
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alfredo Redondo
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Esther González-Bartol
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Alejandro Barrero
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Juan Pablo Sánchez-Luna
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - Ana Revilla-Orodea
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - Carlos Baladrón
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - Ana Serrador
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
| | - J Alberto San Román
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain
| | - Ignacio J Amat-Santos
- Departamento de Cardiología, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Centro de Investigación Biomédica en Red Enfermedades Cardiovaculares (CIBERCV), Spain.
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12
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Patient-Specific Immersed Finite Element-Difference Model of Transcatheter Aortic Valve Replacement. Ann Biomed Eng 2023; 51:103-116. [PMID: 36264408 PMCID: PMC9832092 DOI: 10.1007/s10439-022-03047-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2022] [Accepted: 08/03/2022] [Indexed: 01/28/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) first received FDA approval for high-risk surgical patients in 2011 and has been approved for low-risk surgical patients since 2019. It is now the most common type of aortic valve replacement, and its use continues to accelerate. Computer modeling and simulation (CM&S) is a tool to aid in TAVR device design, regulatory approval, and indication in patient-specific care. This study introduces a computational fluid-structure interaction (FSI) model of TAVR with Medtronic's CoreValve Evolut R device using the immersed finite element-difference (IFED) method. We perform dynamic simulations of crimping and deployment of the Evolut R, as well as device behavior across the cardiac cycle in a patient-specific aortic root anatomy reconstructed from computed tomography (CT) image data. These IFED simulations, which incorporate biomechanics models fit to experimental tensile test data, automatically capture the contact within the device and between the self-expanding stent and native anatomy. Further, we apply realistic driving and loading conditions based on clinical measurements of human ventricular and aortic pressures and flow rates to demonstrate that our Evolut R model supports a physiological diastolic pressure load and provides informative clinical performance predictions.
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13
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Gollmann-Tepeköylü C, Nägele F, Engler C, Stoessel L, Zellmer B, Graber M, Hirsch J, Pölzl L, Ruttmann E, Tancevski I, Tiller C, Barbieri F, Stastny L, Reinstadler SJ, Oezpeker UC, Semsroth S, Bonaros N, Grimm M, Feuchtner G, Holfeld J. Different calcification patterns of tricuspid and bicuspid aortic valves and their clinical impact. Interact Cardiovasc Thorac Surg 2022; 35:ivac274. [PMID: 36383200 PMCID: PMC10906007 DOI: 10.1093/icvts/ivac274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2022] [Accepted: 11/15/2022] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVES Mechanical strain plays a major role in the development of aortic calcification. We hypothesized that (i) valvular calcifications are most pronounced at the localizations subjected to the highest mechanical strain and (ii) calcification patterns are different in patients with bicuspid and tricuspid aortic valves. METHODS Multislice computed tomography scans of 101 patients with severe aortic stenosis were analysed using a 3-dimensional post-processing software to quantify calcification of tricuspid aortic valves (n = 51) and bicuspid aortic valves (n = 50) after matching. RESULTS Bicuspid aortic valves exhibited higher calcification volumes and increased calcification of the non-coronary cusp with significantly higher calcification of the free leaflet edge. The non-coronary cusp showed the highest calcium load compared to the other leaflets. Patients with annular calcification above the median had an impaired survival compared to patients with low annular calcification, whereas patients with calcification of the free leaflet edge above the median did not (P = 0.53). CONCLUSIONS Calcification patterns are different in patients with aortic stenosis with bicuspid and tricuspid aortic valves. Patients with high annular calcification might have an impaired prognosis.
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Affiliation(s)
| | - Felix Nägele
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Clemens Engler
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Leon Stoessel
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Berit Zellmer
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Michael Graber
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Jakob Hirsch
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Leo Pölzl
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Elfriede Ruttmann
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Ivan Tancevski
- Department of Internal Medicine II, Medical University of Innsbruck, Austria
| | - Christina Tiller
- Deparment of Internal Medicine III, Medical University of Innsbruck, Austria
| | - Fabian Barbieri
- Deparment of Internal Medicine III, Medical University of Innsbruck, Austria
| | - Lukas Stastny
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | | | | | - Severin Semsroth
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Nikolaos Bonaros
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Michael Grimm
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
| | - Gudrun Feuchtner
- Department of Radiology, Medical University of Innsbruck, Austria
| | - Johannes Holfeld
- Department of Cardiac Surgery, Medical University of Innsbruck, Austria
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14
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Nuis RJ, Yee J, Adrichem R, Hokken TW, Lenzen M, Daemen J, de Jaegere PP, Van Mieghem NM. Incidence and mechanisms of bioprosthetic dysfunction after transcatheter implantation of a mechanically-expandable heart valve. EUROINTERVENTION 2022; 18:769-776. [PMID: 35712763 PMCID: PMC10331974 DOI: 10.4244/eij-d-22-00193] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 05/10/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The mechanically-expandable transcatheter valve is no longer commercially available, yet clinical and echocardiographic surveillance is imperative for thousands of patients who received transcatheter aortic valve implantation (TAVI) with this platform. AIMS We aimed to determine the incidence and mechanism of bioprosthetic valve dysfunction (BVD) following TAVI with mechanically-expandable valves. METHODS From 2013 to 2020, all 234 patients who underwent TAVI with the LOTUS valve were included. BVD was categorised as (i) structural valve deterioration (SVD), (ii) non-structural valve dysfunction (NSVD), (iii) clinical valve thrombosis and (iv) endocarditis, according to the Valve Academic Research Consortium-3 criteria. RESULTS The mean age was 79±7 years, 60% were male, and the mean Society of Thoracic Surgeons score was 4.2±2.9%. The technical success rate was 94% and the 30-day device success rate was 78%. All-cause mortality at 1 year was 15%; median follow-up duration was 36 (IQR 18-60) months during which 47% of patients died. One hundred and three patients had ≥1 type of BVD (44%), which predominantly consisted of NSVD (39%, mostly because of ≥moderate patient-prosthesis mismatch). BVD during follow-up included endocarditis (3.4%), clinical valve thrombosis (3.4%) and SVD (1.3%). Both endocarditis and clinically apparent valve thrombosis occurred early and late after TAVI and resulted in valve-related deaths in 38% and 13% of patients, respectively. Overall, ≥moderate haemodynamic valve deterioration occurred in 5.5% and bioprosthetic failure in 7.3%, leading to valve-related deaths in 36% of cases. CONCLUSIONS BVD represents a relevant health issue after TAVI with a mechanically-expandable valve. Serious but reversible causes of BVD include endocarditis and clinically apparent valve thrombosis, both carrying a time-independent hazard post-TAVI.
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Affiliation(s)
- Rutger-Jan Nuis
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Jay Yee
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Rik Adrichem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Thijmen W Hokken
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Mattie Lenzen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Joost Daemen
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Peter P de Jaegere
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
| | - Nicolas M Van Mieghem
- Department of Cardiology, Erasmus University Medical Center, Rotterdam, the Netherlands
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15
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Antony I, Mehari Abraha H, Hameed A, Conway C. A European update on transcatheter aortic valve implantation (TAVI) in the COVID era. J Anat 2022; 242:50-63. [PMID: 36152032 PMCID: PMC9773167 DOI: 10.1111/joa.13740] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2021] [Revised: 07/26/2022] [Accepted: 07/26/2022] [Indexed: 12/31/2022] Open
Abstract
Minimally invasive approaches for aortic valve replacement are now at the forefront of pathological aortic valve treatment. New trials show comparability of these devices to existing therapies, not only in high-risk surgical cohorts but also in low-risk and intermediate-risk cohorts. This review provides vital clinical and anatomical background to aortic valvular disease treatment guidelines, while also providing an update on transcatheter aortic valve implantation (TAVI) devices in Europe, their interventional trials and associated complications.
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Affiliation(s)
- Ishan Antony
- School of MedicineRCSI University of Medicine and Health SciencesDublinIreland,Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG)RCSI University of Medicine and Health SciencesDublinIreland
| | - Hyab Mehari Abraha
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG)RCSI University of Medicine and Health SciencesDublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College DublinDublinIreland
| | - Aamir Hameed
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG)RCSI University of Medicine and Health SciencesDublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College DublinDublinIreland
| | - Claire Conway
- Department of Anatomy and Regenerative Medicine, Tissue Engineering Research Group (TERG)RCSI University of Medicine and Health SciencesDublinIreland,Trinity Centre for Biomedical Engineering (TCBE)Trinity College DublinDublinIreland
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16
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Cai L, Hao Y, Ma P, Zhu G, Luo X, Gao H. Fluid-structure interaction simulation of calcified aortic valve stenosis. MATHEMATICAL BIOSCIENCES AND ENGINEERING : MBE 2022; 19:13172-13192. [PMID: 36654041 DOI: 10.3934/mbe.2022616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
Calcified aortic valve stenosis (CAVS) is caused by calcium buildup and tissue thickening that impede the blood flow from left ventricle (LV) to aorta. In recent years, CAVS has become one of the most common cardiovascular diseases. Therefore, it is necessary to study the mechanics of aortic valve (AV) caused by calcification. In this paper, based on a previous idealized AV model, the hybrid immersed boundary/finite element method (IB/FE) is used to study AV dynamics and hemodynamic performance under normal and calcified conditions. The computational CAVS model is realized by dividing the AV leaflets into a calcified region and a healthy region, and each is described by a specific constitutive equation. Our results show that calcification can significantly affect AV dynamics. For example, the elasticity and mobility of the leaflets decrease due to calcification, leading to a smaller opening area with a high forward jet flow across the valve. The calcified valve also experiences an increase in local stress and strain. The increased loading due to AV stenosis further leads to a significant increase in left ventricular energy loss and transvalvular pressure gradients. The model predicted hemodynamic parameters are in general consistent with the risk classification of AV stenosis in the clinic. Therefore, mathematical models of AV with calcification have the potential to deepen our understanding of AV stenosis-induced ventricular dysfunction and facilitate the development of computational engineering-assisted medical diagnosis in AV related diseases.
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Affiliation(s)
- Li Cai
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an 710129, China
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Xi'an 710129, China
- Xi'an Key Laboratory of Scientific Computation and Applied Statistics, Xi'an 710129, China
| | - Yu Hao
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an 710129, China
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Xi'an 710129, China
- Xi'an Key Laboratory of Scientific Computation and Applied Statistics, Xi'an 710129, China
| | - Pengfei Ma
- School of Mathematics and Statistics, Northwestern Polytechnical University, Xi'an 710129, China
- NPU-UoG International Cooperative Lab for Computation and Application in Cardiology, Xi'an 710129, China
- Xi'an Key Laboratory of Scientific Computation and Applied Statistics, Xi'an 710129, China
| | - Guangyu Zhu
- School of Energy and Power Engineering, Xi'an Jiaotong University, Xi'an 710049, China
| | - Xiaoyu Luo
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8QQ, UK
| | - Hao Gao
- School of Mathematics and Statistics, University of Glasgow, Glasgow, G12 8QQ, UK
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17
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Hemodynamic Performance of Two Current-Generation Transcatheter Heart Valve Prostheses in Severely Calcified Aortic Valve Stenosis. J Clin Med 2022; 11:jcm11154570. [PMID: 35956185 PMCID: PMC9369986 DOI: 10.3390/jcm11154570] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 07/21/2022] [Accepted: 08/02/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Treatment of severely calcified aortic valve stenosis is associated with a higher rate of paravalvular leakage (PVL) and permanent pacemaker implantation (PPI). We hypothesized that the self-expanding transcatheter heart valve (THV) prostheses Evolut Pro (EPro) is comparable to the balloon-expandable Sapien 3 (S3) regarding hemodynamics, PPI, and clinical outcome in these patients. METHODS From 2014 to 2019, all patients with very severe calcification of the aortic valve who received an EPro or an S3 THV were included. Propensity score matching was utilized to create two groups of 170 patients. RESULTS At discharge, there was significant difference in transvalvular gradients (EPro vs. S3) (dPmean 8.1 vs. 11.1 mmHg, p ≤ 0.001) and indexed effective orifice area (EOAi) (1.1 vs. 0.9, p ≤ 0.001), as well as predicted EOAi (1 vs. 0.9, p ≤ 0.001). Moderate patient prosthesis mismatch (PPM) was significantly lower in the EPro group (17.7% vs. 38%, p ≤ 0.001), as well as severe PPM (2.9% vs. 8.8%, p = 0.03). PPI and the PVL rate as well as stroke, bleeding, vascular complication, and 30-day mortality were comparable. CONCLUSIONS In patients with severely calcified aortic valves, both THVs performed similarly in terms of 30-day mortality, PPI rate, and PVL occurrence. However, patient prothesis mismatch was observed more often in the S3 group, which might be due to the intra-annular design.
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18
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Chekotu JC, Kinahan D, Goodall R, Brabazon D. Influence of Structural Porosity and Martensite Evolution on Mechanical Characteristics of Nitinol via In-Silico Finite Element Approach. MATERIALS (BASEL, SWITZERLAND) 2022; 15:5365. [PMID: 35955298 PMCID: PMC9369952 DOI: 10.3390/ma15155365] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/31/2022] [Accepted: 08/02/2022] [Indexed: 02/04/2023]
Abstract
Nitinol (NiTi) alloys are gaining extensive attention due to their excellent mechanical, superelasticity, and biocompatibility properties. It is difficult to model the complex mechanical behavior of NiTi alloys due to the solid-state diffusionless phase transformations, and the differing elasticity and plasticity presenting from these two phases. In this work, an Auricchio finite element (FE) model was used to model the mechanical behavior of superelastic NiTi and was validated with experimental data from literature. A Representative Volume Element (RVE) was used to simulate the NiTi microstructure, and a microscale study was performed to understand how the evolution of martensite phase from austenite affects the response of the material upon loading. Laser Powder Bed Fusion (L-PBF) is an effective way to build complex NiTi components. Porosity being one of the major defects in Laser Powder Bed Fusion (L-PBF) processes, the model was used to correlate the macroscale effect of porosity (1.4-83.4%) with structural stiffness, dissipated energy during phase transformations, and damping properties. The results collectively summarize the effectiveness of the Auricchio model and show that this model can aid engineers to plan NiTi processing and operational parameters, for example for heat pump, medical implant, actuator, and shock absorption applications.
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Affiliation(s)
- Josiah Cherian Chekotu
- Advanced Metallic Systems Centre for Doctoral Training, I-Form Advanced Manufacturing Research Centre, Dublin City University, D09 NR58 Dublin, Ireland
- Advanced Processing Technology Research Centre, School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NR58 Dublin, Ireland
| | - David Kinahan
- Advanced Metallic Systems Centre for Doctoral Training, I-Form Advanced Manufacturing Research Centre, Dublin City University, D09 NR58 Dublin, Ireland
- Advanced Processing Technology Research Centre, School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NR58 Dublin, Ireland
| | - Russell Goodall
- Advanced Metallic Systems Centre for Doctoral Training, Department of Materials Science and Engineering, University of Sheffield, Sheffield S1 3JD, UK
| | - Dermot Brabazon
- Advanced Metallic Systems Centre for Doctoral Training, I-Form Advanced Manufacturing Research Centre, Dublin City University, D09 NR58 Dublin, Ireland
- Advanced Processing Technology Research Centre, School of Mechanical and Manufacturing Engineering, Dublin City University, D09 NR58 Dublin, Ireland
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19
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Nappi F, Avtaar Singh SS, Nappi P, Fiore A. Biomechanics of Transcatheter Aortic Valve Implant. Bioengineering (Basel) 2022; 9:bioengineering9070299. [PMID: 35877350 PMCID: PMC9312295 DOI: 10.3390/bioengineering9070299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has grown exponentially within the cardiology and cardiac surgical spheres. It has now become a routine approach for treating aortic stenosis. Several concerns have been raised about TAVI in comparison to conventional surgical aortic valve replacement (SAVR). The primary concerns regard the longevity of the valves. Several factors have been identified which may predict poor outcomes following TAVI. To this end, the lesser-used finite element analysis (FEA) was used to quantify the properties of calcifications which affect TAVI valves. This method can also be used in conjunction with other integrated software to ascertain the functionality of these valves. Other imaging modalities such as multi-detector row computed tomography (MDCT) are now widely available, which can accurately size aortic valve annuli. This may help reduce the incidence of paravalvular leaks and regurgitation which may necessitate further intervention. Structural valve degeneration (SVD) remains a key factor, with varying results from current studies. The true incidence of SVD in TAVI compared to SAVR remains unclear due to the lack of long-term data. It is now widely accepted that both are part of the armamentarium and are not mutually exclusive. Decision making in terms of appropriate interventions should be undertaken via shared decision making involving heart teams.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
- Correspondence: ; Tel.: +33-149334104; Fax: +33-149334119
| | | | - Pierluigi Nappi
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France;
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20
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Yao J, Bosi GM, Burriesci G, Wurdemann H. Computational Analysis of Balloon Catheter Behaviour at Variable Inflation Levels. ANNUAL INTERNATIONAL CONFERENCE OF THE IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. IEEE ENGINEERING IN MEDICINE AND BIOLOGY SOCIETY. ANNUAL INTERNATIONAL CONFERENCE 2022; 2022:3015-3019. [PMID: 36083934 DOI: 10.1109/embc48229.2022.9871164] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Aortic valvuloplasty is a minimally invasive procedure for the dilatation of stenotic aortic valves. Rapid ventricular pacing is an established technique for balloon stabilization during this procedure. However, low cardiac output due to the pacing is one of the inherent risks, which is also associated with several potential complications. This paper proposes a numerical modelling approach to understand the effect of different inflation levels of a valvuloplasty balloon catheter on the positional instability caused by a pulsating blood flow. An unstretched balloon catheter model was crimped into a tri-folded configuration and inflated to several levels. Ten different inflation levels were then tested, and a Fluid-Structure Interaction model was built to solve interactions between the balloon and the blood flow modelled in an idealised aortic arch. Our computational results show that the maximum displacement of the balloon catheter increases with the inflation level, with a small step at around 50% inflation and a sharp increase after reaching 85% inflation. This work represents a substantial progress towards the use of simulations to solve the interactions between a balloon catheter and pulsating blood flow.
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21
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Barati S, Fatouraee N, Nabaei M, Petrini L, Migliavacca F, Luraghi G, Matas JFR. Patient-specific multi-scale design optimization of transcatheter aortic valve stents. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106912. [PMID: 35640391 DOI: 10.1016/j.cmpb.2022.106912] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Transcatheter aortic valve implantation (TAVI) has become the standard treatment for a wide range of patients with aortic stenosis. Although some of the TAVI post-operative complications are addressed in newer designs, other complications and lack of long-term and durability data on the performance of these prostheses are limiting this procedure from becoming the standard for heart valve replacements. The design optimization of these devices with the finite element and optimization techniques can help increase their performance quality and reduce the risk of malfunctioning. Most performance metrics of these prostheses are morphology-dependent, and the design and the selection of the device before implantation should be planned for each individual patient. METHODS In this study, a patient-specific aortic root geometry was utilized for the crimping and implantation simulation of 50 stent samples. The results of simulations were then evaluated and used for developing regression models. The strut width and thickness, the number of cells and patterns, the size of stent cells, and the diameter profile of the stent were optimized with two sets of optimization processes. The objective functions included the maximum crimping strain, radial strength, anchorage area, and the eccentricity of the stent. RESULTS The optimization process was successful in finding optimal models with up to 40% decrease in the maximum crimping strain, 261% increase in the radial strength, 67% reduction in the eccentricity, and about an eightfold increase in the anchorage area compared to the reference device. CONCLUSIONS The stents with larger distal diameters perform better in the selected objective functions. They provide better anchorage in the aortic root resulting in a smaller gap between the device and the surrounding tissue and smaller contact pressure. This framework can be used in designing patient-specific stents and improving the performance of these devices and the outcome of the implantation process.
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Affiliation(s)
- Sara Barati
- Biological Fluid Dynamics Research Laboratory, Biomedical Engineering Department, Amirkabir University of Technology, 350 Hafez Ave, Tehran, Iran
| | - Nasser Fatouraee
- Biological Fluid Dynamics Research Laboratory, Biomedical Engineering Department, Amirkabir University of Technology, 350 Hafez Ave, Tehran, Iran.
| | - Malikeh Nabaei
- Biological Fluid Dynamics Research Laboratory, Biomedical Engineering Department, Amirkabir University of Technology, 350 Hafez Ave, Tehran, Iran
| | - Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Giulia Luraghi
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy.
| | - Josè Felix Rodriguez Matas
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy.
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22
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Factibilidad del alineamiento comisural y coronario precisos con TAVI balón-expandible. Rev Esp Cardiol 2022. [DOI: 10.1016/j.recesp.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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23
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Design of an aortic polymeric valve with asymmetric leaflets and evaluation of its performance by finite element method. Comput Biol Med 2022; 145:105440. [PMID: 35339848 DOI: 10.1016/j.compbiomed.2022.105440] [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: 01/03/2022] [Revised: 02/28/2022] [Accepted: 03/20/2022] [Indexed: 11/23/2022]
Abstract
BACKGROUND The geometry of leaflets plays a significant role in prosthetic valves' (PVs) performance. Typically, natural aortic valves have three unequal leaflets, which differ in size. The present study aims to design an asymmetric tri-leaflet polymeric valve with one large and two small leaflets based on commissure lengths and leaflet eccentricities. METHODS Eccentricity was related to commissure lengths based on the deformation of the free margins for the fully-opened state of leaflets. The polystyrene-block-polyethylene-polypropylene-block-polystyrene polymer characterized the material properties of the leaflets. The Finite Element Method (FEM) was used to evaluate performance parameters, including maximum geometric orifice area (GOA), average GOA, maximum von Mises stress, and leaflet's coaptation surface area (CSA). RESULTS Asymmetric valves with no eccentricity provided a low level of GOA because the asymmetric form of small leaflets caused them to close faster than the large leaflet, leading to a sudden drop in the GOA during systole. As the radial curve tends towards a straight line, an undesirable coaptation occurs, and peak stress increases despite higher GOAs. A new radial curve consisting of two straight lines connected by an arc that provided 25.64 mm2 coaptation surface area (CAS) and 117.54 mm2 average GOA, was proposed to improve coaptation and GOA. CONCLUSION The radial curve of leaflets affects the valve's performance more than other geometric parameters. The combination of straight lines and arcs for radial curves was selected as the reference model for asymmetric valves with one large and two small leaflets.
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24
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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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25
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Sadrabadi MS, Eskandari M, Feigenbaum HP, Arzani A. Local and global growth and remodeling in calcific aortic valve disease and aging. J Biomech 2021; 128:110773. [PMID: 34628201 DOI: 10.1016/j.jbiomech.2021.110773] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2021] [Revised: 08/31/2021] [Accepted: 09/22/2021] [Indexed: 11/19/2022]
Abstract
Aging and calcific aortic valve disease (CAVD) are the main factors leading to aortic stenosis. Both processes are accompanied by growth and remodeling pathways that play a crucial role in aortic valve pathophysiology. Herein, a computational growth and remodeling (G&R) framework was developed to investigate the effects of aging and calcification on aortic valve dynamics. Particularly, an algorithm was developed to couple the global growth and stiffening of the aortic valve due to aging and the local growth and stiffening due to calcification with the aortic valve transient dynamics. The aortic valve dynamics during baseline were validated with available data in the literature. Subsequently, the changes in aortic valve dynamic patterns during aging and CAVD progression were studied. The results revealed the patterns in geometric orifice area reduction and an increase in the valve stress during local and global growth and remodeling of the aortic valve. The proposed algorithm provides a framework to couple mechanobiology models of disease growth with tissue-scale transient structural mechanics models to study the biomechanical changes during cardiovascular disease growth and aging.
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Affiliation(s)
| | - Mona Eskandari
- Department of Mechanical Engineering, University of California Riverside, Riverside, CA, USA; BREATHE Center at the School of Medicine, University of California Riverside, Riverside, CA, USA; Department of Bioengineering, University of California Riverside, Riverside, CA, USA
| | - Heidi P Feigenbaum
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, USA
| | - Amirhossein Arzani
- Department of Mechanical Engineering, Northern Arizona University, Flagstaff, AZ, USA.
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26
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Chevance V, Valter R, Nouri MR, Sifaoui I, Moussafeur A, Lepeule R, Bergoend E, Mule S, Tacher V, Huguet R, Folliguet T, Canoui-Poitrine F, Lim P, Deux JF. Should We Quantify Valvular Calcifications on Cardiac CT in Patients with Infective Endocarditis? J Clin Med 2021; 10:4458. [PMID: 34640477 PMCID: PMC8509527 DOI: 10.3390/jcm10194458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 09/21/2021] [Accepted: 09/27/2021] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Evaluate the impact of valvular calcifications measured on cardiac computed tomography (CCT) in patients with infective endocarditis (IE). METHODS Seventy patients with native IE (36 aortic IE, 31 mitral IE, 3 bivalvular IE) were included and explored with CCT between January 2016 and April 2018. Mitral and aortic valvular calcium score (VCS) were measured on unenhanced calcium scoring images, and correlated with clinical, surgical data, and 1-year death rate. RESULTS VCS of patients with mitral IE and no peripheral embolism was higher than those with peripheral embolism (868 (25-1725) vs. 6 (0-95), p < 0.05). Patients with high calcified mitral IE (mitral VCS > 100; n = 15) had a lower rate of surgery (40.0% vs.78.9%; p = 0.03) and a higher 1-year-death risk (53.3% vs. 10.5%, p = 0.04; OR = 8.5 (2.75-16.40) than patients with low mitral VCS (n = 19). Patients with aortic IE and high aortic calcifications (aortic VCS > 100; n = 18) present more frequently atypical bacteria on blood cultures (33.3% vs. 4.8%; p = 0.03) than patients with low aortic VCS (n = 21). CONCLUSION The amount of valvular calcifications on CT was associated with embolism risk, rate of surgery and 1-year risk of death in patients with mitral IE, and germ's type in aortic IE raising the question of their systematic quantification in native IE.
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Affiliation(s)
- Virgile Chevance
- AP-HP, Hopital Henri Mondor, Service de Radiologie, IMRB, F-94010 Créteil, France; (M.R.N.); (I.S.); (S.M.); (V.T.); (J.-F.D.)
| | - Remi Valter
- AP-HP, Hopital Henri Mondor, Service de Santé Publique, IMRB, F-94010 Créteil, France; (R.V.); (F.C.-P.)
| | - Mohamed Refaat Nouri
- AP-HP, Hopital Henri Mondor, Service de Radiologie, IMRB, F-94010 Créteil, France; (M.R.N.); (I.S.); (S.M.); (V.T.); (J.-F.D.)
| | - Islem Sifaoui
- AP-HP, Hopital Henri Mondor, Service de Radiologie, IMRB, F-94010 Créteil, France; (M.R.N.); (I.S.); (S.M.); (V.T.); (J.-F.D.)
| | - Amina Moussafeur
- AP-HP, Hopital Henri Mondor, Service de Cardiologie, IMRB, F-94010 Créteil, France; (A.M.); (R.H.); (P.L.)
| | - Raphael Lepeule
- AP-HP, Hopital Henri Mondor, Département de Prévention, Diagnostic et Traitement des Infections, IMRB, F-94010 Créteil, France;
| | - Eric Bergoend
- Service de Chirurgie Cardiaque Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94010 Créteil, France; (E.B.); (T.F.)
| | - Sebastien Mule
- AP-HP, Hopital Henri Mondor, Service de Radiologie, IMRB, F-94010 Créteil, France; (M.R.N.); (I.S.); (S.M.); (V.T.); (J.-F.D.)
| | - Vania Tacher
- AP-HP, Hopital Henri Mondor, Service de Radiologie, IMRB, F-94010 Créteil, France; (M.R.N.); (I.S.); (S.M.); (V.T.); (J.-F.D.)
- Unité INSERM U955 Team 18, IMRB, F-94010 Creteil, France
| | - Raphaelle Huguet
- AP-HP, Hopital Henri Mondor, Service de Cardiologie, IMRB, F-94010 Créteil, France; (A.M.); (R.H.); (P.L.)
| | - Thierry Folliguet
- Service de Chirurgie Cardiaque Assistance Publique-Hôpitaux de Paris (AP-HP), Hôpitaux Universitaires Henri Mondor, F-94010 Créteil, France; (E.B.); (T.F.)
- Unité INSERM U955 Team 18, IMRB, F-94010 Creteil, France
| | - Florence Canoui-Poitrine
- AP-HP, Hopital Henri Mondor, Service de Santé Publique, IMRB, F-94010 Créteil, France; (R.V.); (F.C.-P.)
- Unité INSERM U955 Team 18, IMRB, F-94010 Creteil, France
- Clinical Epidemiology and Ageing Unit, Institute Mondor de Recherche Biomédicale, Paris-Est University, F-94000 Créteil, France
| | - Pascal Lim
- AP-HP, Hopital Henri Mondor, Service de Cardiologie, IMRB, F-94010 Créteil, France; (A.M.); (R.H.); (P.L.)
- Unité INSERM U955 Team 18, IMRB, F-94010 Creteil, France
| | - Jean-François Deux
- AP-HP, Hopital Henri Mondor, Service de Radiologie, IMRB, F-94010 Créteil, France; (M.R.N.); (I.S.); (S.M.); (V.T.); (J.-F.D.)
- Unité INSERM U955 Team 18, IMRB, F-94010 Creteil, France
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27
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Whelan A, Williams E, Fitzpatrick E, Murphy BP, Gunning PS, O'Reilly D, Lally C. Collagen fibre-mediated mechanical damage increases calcification of bovine pericardium for use in bioprosthetic heart valves. Acta Biomater 2021; 128:384-392. [PMID: 33945880 DOI: 10.1016/j.actbio.2021.04.046] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2020] [Revised: 04/20/2021] [Accepted: 04/22/2021] [Indexed: 10/21/2022]
Abstract
In cases of aortic stenosis, bioprosthetic heart valves (BHVs), with glutaraldehyde-fixed bovine pericardium leaflets (GLBP), are often implanted to replace the native diseased valve. Widespread use of BHVs, however, is restricted due to inadequate long-term durability, owing specifically to premature leaflet failure. Mechanical fatigue damage and calcification remain the primary leaflet failure modes, where glutaraldehyde treatment is known to accelerate calcification. The literature in this area is limited, with some studies suggesting mechanical damage increases calcification and others that they are independent degenerative mechanisms. In this study, specimens which were non-destructively pre-sorted according to collagen fibre architecture and uniaxially cyclically loaded until failure or 1 million cycles, were placed in an in vitro calcification solution. The weakest specimen group (those with fibres aligned perpendicular to the load) had statistically significantly higher volumes of calcification when compared to those with a high fatigue life. Moreover, SEM imaging revealed that ruptured and damaged fibres presented calcium binding sites; resulting in 4 times more calcification in fractured samples in comparison to those which did not fail by fatigue. To the authors' knowledge, this study quantifies for the first time, that mechanical damage drives calcification in commercial-grade GLBP and that calcification varies spatially according to localised damage levels. These findings illustrate that not only is calcification of GLBP exacerbated by fatigue damage, but that both failure phenomena are underpinned by the collagen fibre organisation. Consequently, controlling for GLBP collagen fibre architecture in leaflets could minimise the progression of these primary failure modes in patient BHVs. STATEMENT OF SIGNIFICANCE: Mechanical damage and calcification are the primary premature failure modes of glutaraldehyde-fixed bovine pericardial (GLBP) leaflets in bioprosthetic heart valves. In this study, commercial-grade GLBP specimens which were uniaxially cyclically loaded to failure or 1 million cycles, were placed in an in vitro calcification solution. MicroCT and SEM analysis showed that localised calcification levels varied spatially according to damage, where ruptured fibres offered additional calcium binding sites. Furthermore, specimens with a statistically significant lower fatigue life were associated with statistically significant higher calcification. This study revealed that mechanical damage drives calcification of GLBP. Non-destructive pre-screening of collagen fibres demonstrated that both the fatigue life and calcification potential of commercial-grade GLBP, are underpinned by the collagen fibre architecture.
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28
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Transcatheter Heart Valve Implantation in Bicuspid Patients with Self-Expanding Device. Bioengineering (Basel) 2021; 8:bioengineering8070091. [PMID: 34356198 PMCID: PMC8301021 DOI: 10.3390/bioengineering8070091] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2021] [Revised: 06/22/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
Bicuspid aortic valve (BAV) patients are conventionally not treated by transcathether aortic valve implantation (TAVI) because of anatomic constraint with unfavorable outcome. Patient-specific numerical simulation of TAVI in BAV may predict important clinical insights to assess the conformability of the transcathether heart valves (THV) implanted on the aortic root of members of this challenging patient population. We aimed to develop a computational approach and virtually simulate TAVI in a group of n.6 stenotic BAV patients using the self-expanding Evolut Pro THV. Specifically, the structural mechanics were evaluated by a finite-element model to estimate the deformed THV configuration in the oval bicuspid anatomy. Then, a fluid–solid interaction analysis based on the smoothed-particle hydrodynamics (SPH) technique was adopted to quantify the blood-flow patterns as well as the regions at high risk of paravalvular leakage (PVL). Simulations demonstrated a slight asymmetric and elliptical expansion of the THV stent frame in the BAV anatomy. The contact pressure between the luminal aortic root surface and the THV stent frame was determined to quantify the device anchoring force at the level of the aortic annulus and mid-ascending aorta. At late diastole, PVL was found in the gap between the aortic wall and THV stent frame. Though the modeling framework was not validated by clinical data, this study could be considered a further step towards the use of numerical simulations for the assessment of TAVI in BAV, aiming at understanding patients not suitable for device implantation on an anatomic basis.
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29
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Martinolli M, Biasetti J, Zonca S, Polverelli L, Vergara C. Extended finite element method for fluid-structure interaction in wave membrane blood pump. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2021; 37:e3467. [PMID: 33884770 DOI: 10.1002/cnm.3467] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/17/2020] [Revised: 03/06/2021] [Accepted: 04/14/2021] [Indexed: 06/12/2023]
Abstract
Numerical simulations of cardiac blood pump systems are integral to the optimization of device design, hydraulic performance and hemocompatibility. In wave membrane blood pumps, blood propulsion arises from the wave propagation along an oscillating immersed membrane, which generates small pockets of fluid that are pushed towards the outlet against an adverse pressure gradient. We studied the Fluid-Structure Interaction between the oscillating membrane and the blood flow via three-dimensional simulations using the Extended Finite Element Method (XFEM), an unfitted numerical technique that avoids remeshing by using a fluid fixed mesh. Our three-dimensional numerical simulations in a realistic pump geometry highlighted, for the first time in this field of application, that XFEM is a reliable strategy to handle complex industrial problems. Moreover, they showed the role of the membrane deformation in promoting a blood flow towards the outlet despite an adverse pressure gradient. We also simulated the pump system at different pressure conditions and we validated the numerical results against in-vitro experimental data.
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Affiliation(s)
- Marco Martinolli
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | | | - Stefano Zonca
- MOX, Dipartimento di Matematica, Politecnico di Milano, Milan, Italy
| | | | - Christian Vergara
- LaBS, Dipartimento di Chimica, Materiali e Ingegneria Chimica "Giulio Natta", Politecnico di Milano, Milan, Italy
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30
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Subject-specific multiscale modeling of aortic valve biomechanics. Biomech Model Mechanobiol 2021; 20:1031-1046. [PMID: 33792805 PMCID: PMC8154826 DOI: 10.1007/s10237-021-01429-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2020] [Accepted: 01/28/2021] [Indexed: 11/13/2022]
Abstract
A Finite Element workflow for the multiscale analysis of the aortic valve biomechanics was developed and applied to three physiological anatomies with the aim of describing the aortic valve interstitial cells biomechanical milieu in physiological conditions, capturing the effect of subject-specific and leaflet-specific anatomical features from the organ down to the cell scale. A mixed approach was used to transfer organ-scale information down to the cell-scale. Displacement data from the organ model were used to impose kinematic boundary conditions to the tissue model, while stress data from the latter were used to impose loading boundary conditions to the cell level. Peak of radial leaflet strains was correlated with leaflet extent variability at the organ scale, while circumferential leaflet strains varied over a narrow range of values regardless of leaflet extent. The dependency of leaflet biomechanics on the leaflet-specific anatomy observed at the organ length-scale is reflected, and to some extent emphasized, into the results obtained at the lower length-scales. At the tissue length-scale, the peak diastolic circumferential and radial stresses computed in the fibrosa correlated with the leaflet surface area. At the cell length-scale, the difference between the strains in two main directions, and between the respective relationships with the specific leaflet anatomy, was even more evident; cell strains in the radial direction varied over a relatively wide range (\documentclass[12pt]{minimal}
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\begin{document}$$0.36-0.87$$\end{document}0.36-0.87) with a strong correlation with the organ length-scale radial strain (\documentclass[12pt]{minimal}
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\begin{document}$$R^{2}= 0.95$$\end{document}R2=0.95); conversely, circumferential cell strains spanned a very narrow range (\documentclass[12pt]{minimal}
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\begin{document}$$0.75-0.88$$\end{document}0.75-0.88) showing no correlation with the circumferential strain at the organ level (\documentclass[12pt]{minimal}
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\begin{document}$$R^{2}= 0.02$$\end{document}R2=0.02). Within the proposed simulation framework, being able to account for the actual anatomical features of the aortic valve leaflets allowed to gain insight into their effect on the structural mechanics of the leaflets at all length-scales, down to the cell scale.
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31
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Loureiro-Ga M, Veiga C, Fdez-Manin G, Jimenez VA, Juan-Salvadores P, Busto L, Baz JA, Iñiguez A. Predicting TAVI paravalvular regurgitation outcomes based on numerical simulation of the aortic annulus eccentricity and perivalvular areas. Comput Methods Biomech Biomed Engin 2021; 24:1629-1637. [PMID: 33779444 DOI: 10.1080/10255842.2021.1906233] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Trans-catheter aortic valve implantation (TAVI) is an increasingly adopted technique which provides a minimal invasive solution for patients who suffer from severe aortic stenosis. Some complications of the procedure could be annular rupture or paravalvular leakage, both related with adverse outcome. In TAVI with balloon expandable devices, a mismatch between those two factors leads to a conflict situation, where improving one worsens the other. The presented research proposes a methodology that uses numerical simulation to obtain certain TAVI outcomes related with aortic regurgitation due to paravalvular leakage, such as perivalvular area, aortic eccentricity or annular pressure. The application of the methodology for two patients shows the possibility of predicting those quantities. The highest stress values are distributed along the contact area. Results also show that a great deformation on the aortic annulus does not necessarily imply a higher stress; pressure can either be converted into root reshape or into root stretching. Validation of the results was done using scientific publications, clinical guidelines and clinical reports. Numerical simulation provides a suitable tool that could possibly contribute to optimize the planification procedure adjusting the mismatch between size and pressure.
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Affiliation(s)
- Marcos Loureiro-Ga
- Cardiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain.,Department of Applied Mathematics II, University of Vigo, Vigo, Spain
| | - Cesar Veiga
- Cardiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | | | | | - Pablo Juan-Salvadores
- Cardiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Laura Busto
- Cardiology Research Group, Galicia Sur Health Research Institute (IIS Galicia Sur), SERGAS-UVIGO, Vigo, Spain
| | - Jose Antonio Baz
- Cardiology Department, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
| | - Andrés Iñiguez
- Cardiology Department, Complexo Hospitalario Universitario de Vigo (CHUVI), Vigo, Spain
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Finotello A, Romarowski RM, Gorla R, Bianchi G, Bedogni F, Auricchio F, Morganti S. Performance of high conformability vs. high radial force devices in the virtual treatment of TAVI patients with bicuspid aortic valve. Med Eng Phys 2021; 89:42-50. [PMID: 33608124 DOI: 10.1016/j.medengphy.2021.02.004] [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: 07/15/2020] [Revised: 01/29/2021] [Accepted: 02/03/2021] [Indexed: 01/17/2023]
Abstract
OBJECTIVE Transcatheter Aortic Valve Implantation (TAVI) is a consolidated procedure showing a low operative risk and excellent long-term outcomes in patients with aortic stenosis. Patients presenting a bicuspid aortic valve (BAV) often require valve replacement due to the highly calcific nature of the aortic leaflets. However, BAV patients have usually been contraindicated for TAVI due to their complex valve anatomy. The aim of this work was to compare the performance of devices featuring high conformability (HC) against those with high radial force (HRF). METHODS Four BAV patients undergoing TAVI were retrospectively selected. The aortic roots including the native leaflets and calcifications were reconstructed from pre-operative Computed Tomography scans. In each patient, both HC and HRF devices were virtually implanted using Finite Element Analysis simulations. After implantation, paravalvular orifice area, von Mises stress distribution, root contact area, and device eccentricity were calculated. RESULTS Simulations showed good agreement with intraoperative imaging. In 3 out of 4 patients, the HRF device resulted in a lower paravalvular area than the HC. Stress distribution was also more homogeneously distributed in the HRF group as compared with the HC group. Despite their lower adaptability, HRF devices showed consistently higher stent-root contact area. CONCLUSION HRF devices showed improved results with respect to HC valves after being deployed in BAV anatomies. We hypothesize that the ability to reshape the annulus is the major determinant of success in this subgroup of patients featuring highly calcified leaflets.
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Affiliation(s)
- Alice Finotello
- Department of Surgical and Integrated Diagnostic Sciences, University of Genoa, Genoa, Italy
| | - Rodrigo M Romarowski
- 3D and Computer Simulation Laboratory, IRCCS Policlinico San Donato, Via Fellini, 4 20097 San Donato Milanese, Italy.
| | - Riccardo Gorla
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Giovanni Bianchi
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Francesco Bedogni
- Department of Clinical and Interventional Cardiology, IRCCS Policlinico San Donato, San Donato Milanese, Italy
| | - Ferdinando Auricchio
- Department of Civil Engineering and Architecture, University of Pavia, Pavia, Italy
| | - Simone Morganti
- Department of Electrical, Computer and Biomedical Engineering, University of Pavia, Pavia, Italy
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33
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Ibanez I, de Azevedo Gomes BA, Nieckele AO. Effect of percutaneous aortic valve position on stress map in ascending aorta: A fluid-structure interaction analysis. Artif Organs 2021; 45:O195-O206. [PMID: 33326639 DOI: 10.1111/aor.13883] [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] [Received: 10/20/2020] [Revised: 12/06/2020] [Accepted: 12/10/2020] [Indexed: 11/30/2022]
Abstract
Transcatheter aortic valve implantation (TAVI) is an increasingly widespread procedure. Although this intervention is indicated for high and low surgical risk patients, some issues still remain, such as prosthesis positioning optimization in the aortic annulus. Coaxial positioning of the percutaneous prosthesis influences directly on the aortic wall stress map. The determination of the mechanical stress that acts on the vascular endothelium resulting from blood flow can be considered an important task, since TAVI positioning can lead to unfavorable hemodynamic patterns, resulting in changes in parietal stress, such as those found in post-stenotic dilatation region. This research aims to investigate the influence of the prosthetic valve inclination angle in the mechanical stresses acting in the ascending aortic wall. Aortic compliance and blood flow during cardiac cycle were numerically obtained using fluid structure interaction. The aortic model was developed through segmentation of a computed tomography image of a specific patient submitted to TAVI. When compared to standard position (coaxiality match between the prosthesis and the aortic annulus), the inclination of 4° directed to the left main coronary artery decreased the aortic wall area with high values of wall shear stress and pressure. Coaxial positioning optimization of percutaneous aortic prosthesis may decrease the high mechanical stress area. These changes may be important to reduce the aortic remodeling process, vascular calcification or even the prosthesis half-life. Computational fluid dynamics makes room for personalized medicine, with manufactured prosthesis tailored to each patient.
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Affiliation(s)
- Ivan Ibanez
- Department of Mechanical Engineering, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
| | - Bruno A de Azevedo Gomes
- Department of Mechanical Engineering, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto Nacional de Cardiologia - MS, Rio de Janeiro, Brazil
| | - Angela O Nieckele
- Department of Mechanical Engineering, Pontifícia Universidade Católica do Rio de Janeiro, Rio de Janeiro, Brazil
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Badria AF, Koutsoukos PG, Mavrilas D. Decellularized tissue-engineered heart valves calcification: what do animal and clinical studies tell us? JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2020; 31:132. [PMID: 33278023 PMCID: PMC7719105 DOI: 10.1007/s10856-020-06462-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Accepted: 10/31/2020] [Indexed: 06/12/2023]
Abstract
Cardiovascular diseases are the first cause of death worldwide. Among different heart malfunctions, heart valve failure due to calcification is still a challenging problem. While drug-dependent treatment for the early stage calcification could slow down its progression, heart valve replacement is inevitable in the late stages. Currently, heart valve replacements involve mainly two types of substitutes: mechanical and biological heart valves. Despite their significant advantages in restoring the cardiac function, both types of valves suffered from serious drawbacks in the long term. On the one hand, the mechanical one showed non-physiological hemodynamics and the need for the chronic anticoagulation therapy. On the other hand, the biological one showed stenosis and/or regurgitation due to calcification. Nowadays, new promising heart valve substitutes have emerged, known as decellularized tissue-engineered heart valves (dTEHV). Decellularized tissues of different types have been widely tested in bioprosthetic and tissue-engineered valves because of their superior biomechanics, biocompatibility, and biomimetic material composition. Such advantages allow successful cell attachment, growth and function leading finally to a living regenerative valvular tissue in vivo. Yet, there are no comprehensive studies that are covering the performance of dTEHV scaffolds in terms of their efficiency for the calcification problem. In this review article, we sought to answer the question of whether decellularized heart valves calcify or not. Also, which factors make them calcify and which ones lower and/or prevent their calcification. In addition, the review discussed the possible mechanisms for dTEHV calcification in comparison to the calcification in the native and bioprosthetic heart valves. For this purpose, we did a retrospective study for all the published work of decellularized heart valves. Only animal and clinical studies were included in this review. Those animal and clinical studies were further subcategorized into 4 categories for each depending on the effect of decellularization on calcification. Due to the complex nature of calcification in heart valves, other in vitro and in silico studies were not included. Finally, we compared the different results and summed up all the solid findings of whether decellularized heart valves calcify or not. Based on our review, the selection of the proper heart valve tissue sources (no immunological provoking residues), decellularization technique (no damaged exposed residues of the decellularized tissues, no remnants of dead cells, no remnants of decellularizing agents) and implantation techniques (avoiding suturing during the surgical implantation) could provide a perfect anticalcification potential even without in vitro cell seeding or additional scaffold treatment.
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Affiliation(s)
- Adel F Badria
- Department of Fiber and Polymer Technology, Division of Coating Technology, KTH Royal Institute of Technology, Stockholm, Sweden.
- Department of Mechanical Engineering and Aeronautics, Division of Applied Mechanics, Technology of Materials and Biomechanics, University of Patras, Patras, Greece.
| | - Petros G Koutsoukos
- Department of Chemical Engineering, University of Patras, Patras University Campus, 26504, Patras, Greece
| | - Dimosthenis Mavrilas
- Department of Mechanical Engineering and Aeronautics, Division of Applied Mechanics, Technology of Materials and Biomechanics, University of Patras, Patras, Greece
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Kostyunin AE, Yuzhalin AE, Rezvova MA, Ovcharenko EA, Glushkova TV, Kutikhin AG. Degeneration of Bioprosthetic Heart Valves: Update 2020. J Am Heart Assoc 2020; 9:e018506. [PMID: 32954917 PMCID: PMC7792365 DOI: 10.1161/jaha.120.018506] [Citation(s) in RCA: 130] [Impact Index Per Article: 32.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
The implantation of bioprosthetic heart valves (BHVs) is increasingly becoming the treatment of choice in patients requiring heart valve replacement surgery. Unlike mechanical heart valves, BHVs are less thrombogenic and exhibit superior hemodynamic properties. However, BHVs are prone to structural valve degeneration (SVD), an unavoidable condition limiting graft durability. Mechanisms underlying SVD are incompletely understood, and early concepts suggesting the purely degenerative nature of this process are now considered oversimplified. Recent studies implicate the host immune response as a major modality of SVD pathogenesis, manifested by a combination of processes phenocopying the long‐term transplant rejection, atherosclerosis, and calcification of native aortic valves. In this review, we summarize and critically analyze relevant studies on (1) SVD triggers and pathogenesis, (2) current approaches to protect BHVs from calcification, (3) obtaining low immunogenic BHV tissue from genetically modified animals, and (4) potential strategies for SVD prevention in the clinical setting.
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Affiliation(s)
- Alexander E Kostyunin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Arseniy E Yuzhalin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation.,Department of Molecular and Cellular Oncology The University of Texas MD Anderson Cancer Center Houston TX
| | - Maria A Rezvova
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Evgeniy A Ovcharenko
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Tatiana V Glushkova
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
| | - Anton G Kutikhin
- Department of Experimental Medicine Research Institute for Complex Issues of Cardiovascular Diseases Kemerovo Russian Federation
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Luraghi G, Matas JFR, Beretta M, Chiozzi N, Iannetti L, Migliavacca F. The impact of calcification patterns in transcatheter aortic valve performance: a fluid-structure interaction analysis. Comput Methods Biomech Biomed Engin 2020; 24:375-383. [PMID: 32924580 DOI: 10.1080/10255842.2020.1817409] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) strongly depends on the calcification patterns, which may lead to a malapposition of the stented valve and complication onsets in terms of structure kinematics and paravalvular leakage (PVL). From one anatomical-resembling model of the aortic root, six configurations with different calcific deposits were built. TAVR fluid-structure interaction simulations predicted different outcomes for the different calcifications patterns in terms of the final valve configuration in the implantation site and the PVL estimations. In particular models with deposits along the cups coaptation resulted in mild PVL, while those with deposits along the attachment line in moderate PVL.
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Affiliation(s)
- Giulia Luraghi
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Jose Felix Rodriguez Matas
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Marta Beretta
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Milan, Italy
| | - Nicole Chiozzi
- 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
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Zaccaria A, Migliavacca F, Pennati G, Petrini L. Modeling of braided stents: Comparison of geometry reconstruction and contact strategies. J Biomech 2020; 107:109841. [DOI: 10.1016/j.jbiomech.2020.109841] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2019] [Revised: 04/21/2020] [Accepted: 05/05/2020] [Indexed: 11/25/2022]
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Nappi F, Nenna A, Sing SSA, Timofeeva I, Mihos C, Gentile F, Chello M. Are the dynamic changes of the aortic root determinant for thrombosis or leaflet degeneration after transcatheter aortic valve replacement? J Thorac Dis 2020; 12:2919-2925. [PMID: 32642204 PMCID: PMC7330384 DOI: 10.21037/jtd.2020.02.01] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
The role of the aortic root is to convert the accumulated elastic energy during systole into kinetic flow energy during diastole, in order to improve blood distribution in the coronary tree. Therefore, the sinuses of Valsalva of the aortic root are not predisposed to accept any bulky material, especially in case of uncrushed solid calcific agglomerates. This concept underlines the differences between surgical aortic valve replacement, in which decalcification is a main part of the procedure, and transcatheter aortic valve replacement (TAVR). Cyclic changes in shape and size of the aortic root influence blood flow in the Valsalva sinuses. Recent papers have been investigating the dynamic changes of the aortic root and whether those differences might be correlated with clinical effects, and this paper aims to summarize part of this flourishing literature. Post-TAVR aortic root remodeling, dynamic flow and TAVR complications might have a fluidodynamic background, and clinically observed side effects such as thrombosis or leaflet degeneration should be further investigated in basic researches. Also, aortic root changes could impact valve type and size selection, affecting the decision of over-sizing or under-sizing in order to prevent valve embolization or coronary ostia obstruction.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Antonio Nenna
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
| | - Sanjeet Singh Avvtar Sing
- Department of Cardiac Surgery, Golden Jubilee National Hospital, Glasgow, UK.,Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK
| | - Irina Timofeeva
- Department of Imaging, Centre Cardiologique du Nord de Saint-Denis, Paris, France
| | - Christos Mihos
- Echocardiography Lab, Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami, USA
| | | | - Massimo Chello
- Department of Cardiovascular Surgery, Università Campus Bio-Medico di Roma, Rome, Italy
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Pasta S, Cannata S, Gentile G, Di Giuseppe M, Cosentino F, Pasta F, Agnese V, Bellavia D, Raffa GM, Pilato M, Gandolfo C. Simulation study of transcatheter heart valve implantation in patients with stenotic bicuspid aortic valve. Med Biol Eng Comput 2020; 58:815-829. [DOI: 10.1007/s11517-020-02138-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2019] [Accepted: 01/22/2020] [Indexed: 12/19/2022]
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Sadipour M, Hanafizadeh P, Sadeghy K, Sattari A. Effect of Aortic Wall Deformation with Healthy and Calcified Annulus on Hemodynamic Performance of Implanted On-X Valve. Cardiovasc Eng Technol 2020; 11:141-161. [PMID: 31912432 DOI: 10.1007/s13239-019-00453-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Accepted: 12/24/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION In this research, the hemodynamic performance of a 23-mm On-X bileaflet mechanical heart valve (BMHV) was investigated with the realistic geometry model of the valve and the deformable aorta in accelerating systole. In addition, the effect of ascending aorta flexibility and aortic annulus calcification on the complex blood flow characteristics were investigated. METHODS The geometry of the aorta is derived from the medical images, and the Ogden model has been utilized for the mechanical behavior of the ascending aorta. The 3D numerical simulation by a two-way Fluid-Structure Interaction (FSI) analysis using the Arbitrary Lagrangian-Eulerian (ALE) method was performed throughout the accelerating systolic phase. RESULTS The dynamics of the leaflets are investigated, and blood flow characteristics such as velocities, vorticities as well as viscous and turbulent shear stress were precisely captured in the flow domain specifically in the hinge region. Streamline results are in accordance with the previously reported data, which show that the flared On-X valves inlet yields a more uniform flow in accelerating systole. Simulations show that aorta flexibility or valve annulus calcification causes variations up to 7% in maximum fluid velocity and 20% in Turbulence Kinetic Energy (TKE). CONCLUSIONS In this study, the complex flow field characteristics in the new generation of BMHVs considering aorta flexibility with healthy and calcified annulus were investigated. It was found that the blood flow around the hinges region is in the danger of hemolysis and platelet activation and subsequently thromboembolism. Furthermore, the results show that similar to vessel wall deformation, considering the probable annulus calcification after valve replacement is also essential.
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Affiliation(s)
- Masod Sadipour
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Pedram Hanafizadeh
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran.
| | - Keyvan Sadeghy
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
| | - Amirmohammad Sattari
- School of Mechanical Engineering, College of Engineering, University of Tehran, Tehran, Iran
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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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Wu MCH, Muchowski HM, Johnson EL, Rajanna MR, Hsu MC. Immersogeometric fluid-structure interaction modeling and simulation of transcatheter aortic valve replacement. COMPUTER METHODS IN APPLIED MECHANICS AND ENGINEERING 2019; 357:112556. [PMID: 32831419 PMCID: PMC7442159 DOI: 10.1016/j.cma.2019.07.025] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative to surgical treatments of valvular heart disease. TAVR offers many advantages, however, the safe anchoring of the transcatheter heart valve (THV) in the patients anatomy is key to a successful procedure. In this paper, we develop and apply a novel immersogeometric fluid-structure interaction (FSI) framework for the modeling and simulation of the TAVR procedure to study the anchoring ability of the THV. To account for physiological realism, methods are proposed to model and couple the main components of the system, including the arterial wall, blood flow, valve leaflets, skirt, and frame. The THV is first crimped and deployed into an idealized ascending aorta. During the FSI simulation, the radial outward force and friction force between the aortic wall and the THV frame are examined over the entire cardiac cycle. The ratio between these two forces is computed and compared with the experimentally estimated coefficient of friction to study the likelihood of valve migration.
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Affiliation(s)
- Michael C. H. Wu
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
- School of Engineering, Brown University, 184 Hope Street, Providence, Rhode Island 02912, USA
| | - Heather M. Muchowski
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
- Department of Mathematics, Iowa State University, 396 Carver Hall, Ames, Iowa 50011, USA
| | - Emily L. Johnson
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
| | - Manoj R. Rajanna
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
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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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Numerical models of valve-in-valve implantation: effect of intentional leaflet laceration on the anchorage. Biomech Model Mechanobiol 2019; 19:415-426. [DOI: 10.1007/s10237-019-01218-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2019] [Accepted: 08/22/2019] [Indexed: 11/26/2022]
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45
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Cristoforetti A, Masè M, Bonmassari R, Dallago M, Nollo G, Ravelli F. A patient-specific mass-spring model for biomechanical simulation of aortic root tissue during transcatheter aortic valve implantation. Phys Med Biol 2019; 64:085014. [PMID: 30884468 DOI: 10.1088/1361-6560/ab10c1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
The success of transcatheter aortic valve implantation (TAVI) is highly dependent on the prediction of the interaction between the prosthesis and the aortic root anatomy. The simulation of the surgical procedure may be useful to guide artificial valve selection and delivery, nevertheless the introduction of simulation models into the clinical workflow is often hindered by model complexity and computational burden. To address this point, we introduced a patient-specific mass-spring model (MSM) with viscous damping, as a good trade-off between simulation accuracy and time-efficiency. The anatomical model consisted of a hexahedral mesh, segmented from pre-procedural patient-specific cardiac computer tomographic (CT) images of the aortic root, including valve leaflets and attached calcifications. Nodal forces were represented by linear-elastic springs acting on edges and angles. A fast integration approach based on the modulation of nodal masses was also tested. The model was validated on seven patients, comparing simulation results with post-procedural CT images with respect to calcification and aortic wall position. The validation showed that the MSM was able to predict calcification displacement with an average accuracy of 1.72 mm and 1.54 mm for the normal and fast integration approaches, respectively. Wall displacement root mean squared error after valve expansion was about 1 mm for both approaches, showing an improved matching with respect to the pre-procedural configuration. In terms of computational burden, the fast integration approach allowed a consistent reduction of the computational times, which decreased from 36 h to 21.8 min per 100 K hexahedra. Our findings suggest that the proposed linear-elastic MSM model may provide good accuracy and reduced computational times for TAVI simulations, fostering its inclusion in clinical routines.
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Affiliation(s)
- Alessandro Cristoforetti
- Department of Industrial Engineering, University of Trento, Trento, Italy. Department of Physics, University of Trento, Trento, Italy
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Butter C, Okamoto M, Schymik G, Jacobshagen C, Rothe J, Treede H, Kerber S, Frank D, Bramlage P, Sykorova L, Thoenes M, Rudolph TK. Degree of valve calcification in patients undergoing transfemoral transcatheter aortic valve implantation with and without balloon aortic valvuloplasty: Findings from the multicenter EASE-IT TF registry. Catheter Cardiovasc Interv 2019; 94:469-478. [PMID: 30866154 DOI: 10.1002/ccd.28164] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2018] [Accepted: 02/09/2019] [Indexed: 12/17/2022]
Abstract
AIMS We aimed to assess whether the level of aortic root calcification is associated with BAV performance/omission during transcatheter aortic valve implantation (TAVI), and to explore related outcomes. METHODS AND RESULTS EASE-IT TF was a prospective, observational, multicenter registry of patients undergoing TF-TAVI with the Edwards SAPIEN 3, with or without BAV predilation. Valvular calcification was quantified from pre-procedural multi-slice computed tomography images and compared between BAV and no BAV patients. Data for 178 patients (55 BAV; 123 no BAV) were analyzed. There were no significant differences between groups in terms of regional/leaflet sector calcification volumes, maximum asymmetry between the different leaflet sectors, or total calcification scores. Overall, a greater-than-average leaflet calcification volume was independently predictive of ≥mild PVL (OR: 5.116; 95% CI: 1.042-38.35) and the need for post-dilation (OR: 3.592; 95% CI: 1.173-12.14). The latter effect was abated in patients with BAV (OR: 1.837; 95% CI: 0.223-18.00) and intensified in those without BAV (OR: 5.575; 95% CI: 1.114-38.74). No other BAV-dependent effects of calcification on outcomes were observed. CONCLUSIONS In the majority of transfemoral valve implantations, calcification does not appear to be the main driving factor in the decision to perform/omit BAV. Predilation may be valuable for reducing post-dilation requirements in patients only with a greater degree of leaflet calcification.
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Affiliation(s)
- Christian Butter
- Department of Cardiology, Immanuel Clinic Bernau, Heart Center Brandenburg and Brandenburg Medical School (MHB), Bernau bei Berlin, Germany
| | - Maki Okamoto
- Department of Cardiology, Immanuel Clinic Bernau, Heart Center Brandenburg and Brandenburg Medical School (MHB), Bernau bei Berlin, Germany
| | - Gerhard Schymik
- Medical Clinic IV, Department of Cardiology, Municipal Hospital, Karlsruhe, Germany
| | | | - Jürgen Rothe
- Division of Cardiology and Angiology II, University Heart Centre Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Hendrik Treede
- Universitätsklinik und Poliklinik für Herzchirurgie, Universitätsklinikum Halle, Halle, Germany
| | - Sebastian Kerber
- Department of Cardiology, Cardiovascular Center, Bad Neustadt, Germany
| | - Derk Frank
- ZHK (German Centre for Cardiovascular Research), Hamburg, Germany.,Department of Internal Medicine III (Cardiology and Angiology), University Hospital Schleswig-Holstein, Kiel, Germany
| | - Peter Bramlage
- Institute for Pharmacology and Preventive Medicine, Cloppenburg, Germany
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Marinho E, Carbonari RC, Malmonge SM, Leão CR. Mechanical behavior of bovine pericardium treated with hyaluronic acid derivative for bioprosthetic aortic valves. J Biomed Mater Res B Appl Biomater 2019; 107:2273-2280. [PMID: 30684295 DOI: 10.1002/jbm.b.34319] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2018] [Revised: 12/04/2018] [Accepted: 12/19/2018] [Indexed: 11/07/2022]
Abstract
We studied the mechanical behavior of bovine pericardium (BP) after anticalcification treatment using hyaluronic acid (HA) derivative. To simulate the physiological environment and stimulate the calcification process, the BP samples were immersed into simulated body fluid solution. We conducted scanning electron microscopy with energy dispersive X-ray spectrometry, and uniaxial mechanical tests of HA-treated and non-treated samples. Although our microstructural analyses indicated that the HA treatment actually prevents the formation of calcium phosphate deposits, the mechanical tests show significant increase of stiffness of the HA-treated samples. Using data from our mechanical tests as input parameters, we performed finite element (FE) computer simulations to estimate how this increase in the BP stiffness affects the stress distribution in the bioprosthetic leaflet. Although the maximum stress observed during the closing phase of the membrane in vivo is below the experimental yield stress in all cases we analyzed, our FE results indicate that increase of BP stiffness due to HA anticalcification treatment results in higher risk of disruption and failure of the leaflets in bioprosthetic heart valves. Since our FE results indicate that the commissure and the fixed edge are the regions that withstand the highest mechanical stresses during the closing phase, new designs of the valve might be efficient to enhance the endurance of the prosthesis. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 2273-2280, 2019.
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Affiliation(s)
- Enesio Marinho
- Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, Avenida dos Estados, 5001, Santo André, São Paulo, 09210-580, Brazil
| | - Ronny Calixto Carbonari
- Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, Avenida dos Estados, 5001, Santo André, São Paulo, 09210-580, Brazil
| | - Sonia M Malmonge
- Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, Avenida dos Estados, 5001, Santo André, São Paulo, 09210-580, Brazil
| | - Cedric Rocha Leão
- Centro de Engenharia, Modelagem e Ciências Sociais Aplicadas, Universidade Federal do ABC, Avenida dos Estados, 5001, Santo André, São Paulo, 09210-580, Brazil
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McGee OM, Sun W, McNamara LM. An in vitro model quantifying the effect of calcification on the tissue–stent interaction in a stenosed aortic root. J Biomech 2019; 82:109-115. [DOI: 10.1016/j.jbiomech.2018.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/11/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
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Patient-specific simulation of transcatheter aortic valve replacement: impact of deployment options on paravalvular leakage. Biomech Model Mechanobiol 2018; 18:435-451. [PMID: 30460623 DOI: 10.1007/s10237-018-1094-8] [Citation(s) in RCA: 80] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as an effective alternative to conventional surgical valve replacement in high-risk patients afflicted by severe aortic stenosis. Despite newer-generation devices enhancements, post-procedural complications such as paravalvular leakage (PVL) and related thromboembolic events have been hindering TAVR expansion into lower-risk patients. Computational methods can be used to build and simulate patient-specific deployment of transcatheter aortic valves (TAVs) and help predict the occurrence and degree of PVL. In this study finite element analysis and computational fluid dynamics were used to investigate the influence of procedural parameters on post-deployment hemodynamics on three retrospective clinical cases affected by PVL. Specifically, TAV implantation depth and balloon inflation volume effects on stent anchorage, degree of paravalvular regurgitation and thrombogenic potential were analyzed for cases in which Edwards SAPIEN and Medtronic CoreValve were employed. CFD results were in good agreement with corresponding echocardiography data measured in patients in terms of the PVL jets locations and overall PVL degree. Furthermore, parametric analyses demonstrated that positioning and balloon over-expansion may have a direct impact on the post-deployment TAVR performance, achieving as high as 47% in PVL volume reduction. While the model predicted very well clinical data, further validation on a larger cohort of patients is needed to verify the level of the model's predictions in various patient-specific conditions. This study demonstrated that rigorous and realistic patient-specific numerical models could potentially serve as a valuable tool to assist physicians in pre-operative TAVR planning and TAV selection to ultimately reduce the risk of clinical complications.
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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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