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Shi W, Feng D, Hu X, Wang C, Niu G, Zhao Z, Zhang H, Wang M, Wu Y. Prediction of hypoattenuating leaflet thickening in patients undergoing transcatheter aortic valves replacement based on clinical factors and 4D-computed tomography morphological characteristics: A retrospective cross-sectional study. Int J Cardiol 2024; 410:132219. [PMID: 38815674 DOI: 10.1016/j.ijcard.2024.132219] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 05/22/2024] [Accepted: 05/27/2024] [Indexed: 06/01/2024]
Abstract
BACKGROUND The rapid increase in the number of transcatheter aortic valve replacement (TAVR) procedures in China and worldwide has led to growing attention to hypoattenuating leaflet thickening (HALT) detected during follow-up by 4D-CT. It's reported that HALT may impact the durability of prosthetic valve. Early identification of these patients and timely deployment of anticoagulant therapy are therefore particularly important. METHODS We retrospectively recruited 234 consecutive patients who underwent TAVR procedure in Fuwai Hospital. We collected clinical information and extracted morphological characteristics parameters of the transcatheter heart valve (THV) post TAVR procedure from 4D-CT. LASSO analysis was conducted to select important features. Three models were constructed, encapsulating clinical factors (Model 1), morphological characteristics parameters (Model 2), and all together (Model 3), to identify patients with HALT. Receiver operating characteristic (ROC) curves and decision curve analysis (DCA) were plotted to evaluate the discriminatory ability of models. A nomogram for HALT was developed and verified by bootstrap resampling. RESULTS In our study patients, Model 3 (AUC = 0.738) showed higher recognition effectiveness compared to Model 1 (AUC = 0.674, p = 0.032) and Model 2 (AUC = 0.675, p = 0.021). Internal bootstrap validation also showed that Model 3 had a statistical power similar to that of the initial stepwise model (AUC = 0.723 95%CI: 0.661-0.786). Overall, Model 3 was rated best for the identification of HALT in TAVR patients. CONCLUSION A comprehensive predictive model combining patient clinical factors with CT-based morphology parameters has superior efficacy in predicting the occurrence of HALT in TAVR patients.
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Affiliation(s)
- Wence Shi
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Dejing Feng
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Xiangming Hu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Can Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Guannan Niu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Zhenyan Zhao
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Hongliang Zhang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China
| | - Moyang Wang
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
| | - Yongjian Wu
- Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Disease, Chinese Academy of Medical Science and Peking Union Medical College, Beijing, China.
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Bornemann KM, Jahren SE, Obrist D. The relation between aortic morphology and transcatheter aortic heart valve thrombosis: Particle tracing and platelet activation in larger aortic roots with and without neo-sinus. Comput Biol Med 2024; 179:108828. [PMID: 38996554 DOI: 10.1016/j.compbiomed.2024.108828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2024] [Revised: 06/05/2024] [Accepted: 06/29/2024] [Indexed: 07/14/2024]
Abstract
Transcatheter aortic heart valve thrombosis (THVT) affects long-term valve durability, transvalvular pressure gradient and leaflet mobility. In this study, we conduct high-fidelity fluid-structure interaction simulations to perform Lagrangian particle tracing in a generic model with larger aortic diameters (THVT model) with and without neo-sinus which is compared to a model of unaffected TAVI patients (control model). Platelet activation indices are computed for each particle to assess the risk of thrombus formation induced by high shear stresses followed by flow stagnation. Particle tracing indicates that fewer particles contribute to sinus washout of the THVT model with and without neo-sinus compared to the control model (-34.9%/-34.1%). Stagnating particles in the native sinus of the THVT model show higher platelet activation indices than for the control model (+39.6% without neo-sinus, +45.3% with neo-sinus). Highest activation indices are present for particles stagnating in the neo-sinus of the larger aorta representing THVT patients (+80.2% compared to control). This fluid-structure interaction (FSI) study suggests that larger aortas lead to less efficient sinus washout in combination with higher risk of platelet activation among stagnating particles, especially within the neo-sinus. This could explain (a) a higher occurrence of thrombus formation in transcatheter valves compared to surgical valves without neo-sinus and (b) the neo-sinus as the prevalent region for thrombi in TAV. Pre-procedural identification of larger aortic roots could contribute to better risk assessment of patients and improved selection of a patient-specific anti-coagulation therapy.
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Affiliation(s)
- Karoline-Marie Bornemann
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, Bern, 3010, Switzerland.
| | - Silje Ekroll Jahren
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, Bern, 3010, Switzerland
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Freiburgstrasse 3, Bern, 3010, Switzerland
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3
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Chitturi KR, Aladin AI, Braun R, Al-Qaraghuli AK, Banerjee A, Reddy P, Merdler I, Chaturvedi A, Abusnina W, Haberman D, Lupu L, Rodriguez-Weisson FJ, Case BC, Wermers JP, Ben-Dor I, Satler LF, Waksman R, Rogers T. Bioprosthetic Aortic Valve Thrombosis: Definitions, Clinical Impact, and Management: A State-of-the-Art Review. Circ Cardiovasc Interv 2024; 17:e014143. [PMID: 38853766 DOI: 10.1161/circinterventions.123.014143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 06/11/2024]
Abstract
Bioprosthetic aortic valve thrombosis is frequently detected after transcatheter and surgical aortic valve replacement due to advances in cardiac computed tomography angiography technology and standardized surveillance protocols in low-surgical-risk transcatheter aortic valve replacement trials. However, evidence is limited concerning whether subclinical leaflet thrombosis leads to clinical adverse events or premature structural valve deterioration. Furthermore, there may be net harm in the form of bleeding from aggressive antithrombotic treatment in patients with subclinical leaflet thrombosis. This review will discuss the incidence, mechanisms, diagnosis, and optimal management of bioprosthetic aortic valve thrombosis after transcatheter aortic valve replacement and bioprosthetic surgical aortic valve replacement.
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Affiliation(s)
- Kalyan R Chitturi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Amer I Aladin
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Ryan Braun
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (R.B., T.R.)
| | - Abdullah K Al-Qaraghuli
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Avantika Banerjee
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Pavan Reddy
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Ilan Merdler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Abhishek Chaturvedi
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Waiel Abusnina
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Dan Haberman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Lior Lupu
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Fernando J Rodriguez-Weisson
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Brian C Case
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Jason P Wermers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Itsik Ben-Dor
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Lowell F Satler
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Ron Waksman
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
| | - Toby Rogers
- Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (K.R.C., A.I.A., A.K.A.-Q., A.B., P.R., I.M., A.C., W.A., D.H., L.L., F.J.R.-W., B.C.C., J.P.W., I.B.-D., L.F.S., R.W., T.R.)
- Cardiovascular Branch, Division of Intramural Research, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD (R.B., T.R.)
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Molina-Lopez VH, Partida-Rodriguez E, Rivera-Babilonia J, Rodriguez-Ospina L. Successful Rescue Transaortic Valve Replacement Using Edwards Sapien 3 Following Failed Evolut R Implantation in a Degenerated Surgical Bioprosthesis: A Case Report. Cureus 2024; 16:e54318. [PMID: 38496184 PMCID: PMC10944659 DOI: 10.7759/cureus.54318] [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] [Accepted: 02/14/2024] [Indexed: 03/19/2024] Open
Abstract
This study examines a complex scenario of structural valve degeneration (SVD) in a high surgical-risk patient with a previously implanted 25 mm Carpentier-Edwards (CE) Perimount Magna Ease 3300 (Irvine, CA: Edwards Lifesciences) surgical bioprosthetic valve (SAV), the patient presented with both paravalvular leak (PVL) and central prosthetic valve insufficiency (PVI). The patient was considered for a transaortic valve-in-valve (ViV) intervention with a self-expanding 29 mm Evolut R valve (Minneapolis, MN: Medtronic). The case describes a ViV intervention complicated by the malpositioning of the Evolut R valve secondary to micro-dislodgement into the left ventricular outflow tract (LVOT) after deployment and subsequent migration into the LVOT during an attempted bioprosthetic valve fracture (BVF) of the SAV that aimed to decrease transvalvular gradients. The resulting acute severe PVL resulted in significant hemodynamic deterioration, necessitating emergent intervention by implanting a balloon-expandable 26 mm Edwards SAPIEN 3 valve (Irvine, CA: Edwards Lifesciences), effectively averting the need for a surgical valve explant. This study illuminates the intricacies and emergency management strategies in transcatheter aortic valve replacement (TAVR) procedures, particularly in high-risk patients with SVD, and offers critical insights into the challenges and solutions in ViV implantations.
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Affiliation(s)
| | | | - Jaime Rivera-Babilonia
- Interventional Cardiology, VA Caribbean Healthcare System, San Juan, PRI
- Interventional Cardiology, Hospital Pavia, San Juan, PRI
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5
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Kim JH, Sadri V, Chen H, Bhat S, Kohli K, Makkar R, Babaliaros VC, Sharma RP, Yoganathan AP. Effect of Ascending Aortic Curvature on Flow in the Sinus and Neo-sinus Following TAVR: A Patient-Specific Study. Ann Biomed Eng 2024; 52:425-439. [PMID: 37922056 DOI: 10.1007/s10439-023-03392-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 10/23/2023] [Indexed: 11/05/2023]
Abstract
Patient-specific aortic geometry and its influence on the flow in the vicinity of Transcatheter Aortic Valve (TAV) has been highlighted in numerous studies using both in silico and in vitro experiments. However, there has not yet been a detailed Particle Image Velocimetry (PIV) experiment conducted to quantify the relationship between the geometry, flow downstream of TAV, and the flow in the sinus and the neo-sinus. We tested six different patient-specific aorta models with a 26-mm SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) in a left heart simulator with coronary flow. Velocities in all three cusps and circulation downstream of TAV were computed to evaluate the influence of the ascending aorta curvature on the flow field. The in vitro analysis showed that the patient-specific aortic curvature had positive correlation to the circulation in the ascending aorta (p = 0.036) and circulation had negative correlation to the particle washout time in the cusps (p = 0.011). These results showed that distinct vortical flow patterns in the ascending aorta as the main jet impinges on the aortic wall causes a recirculation region that facilitates the flow back into the sinus and the neo-sinus, thus reducing the risk of flow stagnation and washout time.
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Affiliation(s)
- Jae Hyun Kim
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Vahid Sadri
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Huang Chen
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Sanchita Bhat
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Keshav Kohli
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA
| | - Raj Makkar
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA
| | | | - Rahul P Sharma
- Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA
| | - Ajit P Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA.
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6
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Persia-Paulino YR, Almendarez Lacayo M, Alperi A, Hernández-Vaquero D, Fernández Asensio R, Cuevas Pérez J, Adeba A, Flórez P, Vigil-Escalera M, Álvarez Velasco R, Renilla A, Del Valle Fernández R, Antuña P, Morís de la Tassa C, Avanzas P, Pascual I. Self-expanding TAVI using the cusp overlap technique versus the traditional technique: electrocardiogram changes and 1-year cardiovascular outcomes. REVISTA ESPANOLA DE CARDIOLOGIA (ENGLISH ED.) 2024; 77:29-38. [PMID: 37437882 DOI: 10.1016/j.rec.2023.04.008] [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: 01/20/2023] [Accepted: 04/18/2023] [Indexed: 07/14/2023]
Abstract
INTRODUCTION AND OBJECTIVES Transcatheter aortic valve implantation (TAVI) using the cusp overlap technique (COT) has shown a lower pacemaker implantation rate at 30 days. The objective of this study was to compare electrocardiogram changes and clinical outcomes between COT and the traditional technique (TT) at 1 year of follow-up. METHODS Observational, retrospective, nonrandomized study of consecutive patients undergoing TAVI between January 2015 and January 2021. Patients were matched using a propensity score and the TT was compared with COT. The primary endpoints were electrocardiogram changes and a combined endpoint including pacemaker implantation, hospitalization, or cardiovascular death at 1 year. RESULTS We included 254 patients. After propensity score matching, 184 patients (92 per group) remained. There were no statistically significant differences in baseline characteristics. At 1 year, COT patients showed a significant reduction in new onset left bundle branch block (49% vs 27%, P=.002) and less P wave (13.1±21.0 msec vs 5.47±12.5 msec; P=.003) and QRS prolongation (29.77±27.0 msec vs 16.38±25.4 msec, P <.001). COT was associated with a significant reduction in the occurrence of the primary endpoint (SHR, 0.39 [IC95%, 0.21-0.76]; P=.005). CONCLUSIONS At 1 year of follow-up, COT reduced the incidence of new onset left bundle branch block and diminished QRS and P wave widening compared with the TT. COT was also associated with a statistically significant reduction in the occurrence of the combined primary cardiovascular endpoint.
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Affiliation(s)
- Yván R Persia-Paulino
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Marcel Almendarez Lacayo
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | - Alberto Alperi
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | - Daniel Hernández-Vaquero
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | | | - Javier Cuevas Pérez
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Antonio Adeba
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - Pablo Flórez
- Servicio de Cardiología, Hospital Valle del Nalón, Langreo, Asturias, Spain
| | - María Vigil-Escalera
- Servicio de Cardiología, Hospital Universitario de Cabueñes, Gijón, Asturias, Spain
| | - Rut Álvarez Velasco
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain
| | - Alfredo Renilla
- Servicio de Cardiología, Hospital Vital Álvarez-Buylla, Mieres, Asturias, Spain
| | | | - Paula Antuña
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain
| | - César Morís de la Tassa
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
| | - Pablo Avanzas
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain; Centro de Investigación Biomédica en Red de Enfermedades Cardiovasculares (CIBERCV), Spain.
| | - Isaac Pascual
- Área del Corazón, Hospital Universitario Central de Asturias, Oviedo, Asturias, Spain; Grupo de Investigación de Patología Cardiaca, Instituto de Investigación del Principado de Asturias, Oviedo, Asturias, Spain; Departamento de Medicina, Universidad de Oviedo, Oviedo, Asturias, Spain
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Oks D, Houzeaux G, Vázquez M, Neidlin M, Samaniego C. Effect of TAVR commissural alignment on coronary flow: A fluid-structure interaction analysis. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2023; 242:107818. [PMID: 37837886 DOI: 10.1016/j.cmpb.2023.107818] [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: 05/14/2023] [Revised: 09/07/2023] [Accepted: 09/15/2023] [Indexed: 10/16/2023]
Abstract
BACKGROUND AND OBJECTIVES Coronary obstruction is a complication that may affect patients receiving Transcatheter Aortic Valve Replacement (TAVR), with catastrophic consequences and long-term negative effects. To enable healthy coronary perfusion, it is fundamental to appropriately position the device with respect to the coronary ostia. Nonetheless, most TAVR delivery systems do not control commissural alignment to do so. Moreover, no in silico study has directly assessed the effect of commissural alignment on coronary perfusion. This work aims to evaluate the effect of TAVR commissural alignment on coronary perfusion and device performance. METHODS A two-way computational fluid-structure interaction model is used to predict coronary perfusion at different commissural alignments. Moreover, in each scenario, hemodynamic biomarkers are evaluated to assess device performance. RESULTS Commissural misalignment is shown to reduce the total coronary perfusion by -3.2% and the flow rate to a single coronary branch by -6.8%. It is also observed to impair valvular function by reducing the systolic geometric orifice area by -2.5% and increasing the systolic transvalvular pressure gradients by +5.3% and the diastolic leaflet stresses by +16.0%. CONCLUSIONS The present TAVR patient model indicates that coronary perfusion, hemodynamic and structural performance are minimized when the prosthesis commissures are fully misaligned with the native ones. These results support the importance of enabling axial control in new TAVR delivery catheter systems and defining recommended values of commissural alignment in upcoming clinical treatment guidelines.
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Affiliation(s)
- David Oks
- Barcelona Supercomputing Center, Computer Applications in Science and Engineering, Plaça d'Eusebi Güell, 1-3, 08034, Barcelona, Spain; ELEM Biotech SL, Plaça Pau Vila, 1, Bloc A, Planta 3, Porta 3A1, 08003, Barcelona, Spain.
| | - Guillaume Houzeaux
- Barcelona Supercomputing Center, Computer Applications in Science and Engineering, Plaça d'Eusebi Güell, 1-3, 08034, Barcelona, Spain
| | - Mariano Vázquez
- Barcelona Supercomputing Center, Computer Applications in Science and Engineering, Plaça d'Eusebi Güell, 1-3, 08034, Barcelona, Spain; ELEM Biotech SL, Plaça Pau Vila, 1, Bloc A, Planta 3, Porta 3A1, 08003, Barcelona, Spain
| | - Michael Neidlin
- Department of Cardiovascular Engineering, Institute of Applied Medical Engineering, Medical Faculty, RWTH Aachen University, Pauwelstraße 20, 52074, Aachen, Germany
| | - Cristóbal Samaniego
- Barcelona Supercomputing Center, Computer Applications in Science and Engineering, Plaça d'Eusebi Güell, 1-3, 08034, Barcelona, Spain
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Khodaei S, Abdelkhalek M, Maftoon N, Emadi A, Keshavarz-Motamed Z. Early Detection of Risk of Neo-Sinus Blood Stasis Post-Transcatheter Aortic Valve Replacement Using Personalized Hemodynamic Analysis. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2023; 7:100180. [PMID: 37745677 PMCID: PMC10512011 DOI: 10.1016/j.shj.2023.100180] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 02/27/2023] [Accepted: 03/01/2023] [Indexed: 09/26/2023]
Abstract
Background Despite the demonstrated benefits of transcatheter aortic valve replacement (TAVR), subclinical leaflet thrombosis and hypoattenuated leaflet thickening are commonly seen as initial indications of decreased valve durability and augmented risk of transient ischemic attack. Methods We developed a multiscale patient-specific computational framework to quantify metrics of global circulatory function, metrics of global cardiac function, and local cardiac fluid dynamics of the aortic root and coronary arteries. Results Based on our findings, TAVR might be associated with a high risk of blood stagnation in the neo-sinus region due to the lack of sufficient blood flow washout during the diastole phase (e.g., maximum blood stasis volume increased by 13, 8, and 2.7 fold in the left coronary cusp, right coronary cusp, and noncoronary cusp, respectively [N = 26]). Moreover, in some patients, TAVR might not be associated with left ventricle load relief (e.g., left ventricle load reduced only by 1.2 % [N = 26]) and diastolic coronary flow improvement (e.g., maximum coronary flow reduced by 4.94%, 15.05%, and 23.59% in the left anterior descending, left circumflex coronary artery, and right coronary artery, respectively, [N = 26]). Conclusions The transvalvular pressure gradient amelioration after TAVR might not translate into adequate sinus blood washout, optimal coronary flow, and reduced cardiac stress. Noninvasive personalized computational modeling can facilitate the determination of the most effective revascularization strategy pre-TAVR and monitor leaflet thrombosis and coronary plaque progression post-TAVR.
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Affiliation(s)
- Seyedvahid Khodaei
- Department of Mechanical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Mohamed Abdelkhalek
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Nima Maftoon
- Department of Systems Design Engineering, University of Waterloo, Waterloo, Ontario, Canada
- Centre for Bioengineering and Biotechnology, University of Waterloo, Waterloo, Ontario, Canada
| | - Ali Emadi
- Department of Mechanical Engineering, McMaster University, Hamilton, Ontario, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, Ontario, Canada
| | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering, McMaster University, Hamilton, Ontario, Canada
- School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada
- School of Computational Science and Engineering, McMaster University, Hamilton, Ontario, Canada
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9
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Brunner S, Brinkert M, Moccetti F, Loretz L, Fornaro J, Stämpfli SF, Attinger-Toller A, Bossard M, Buhmann R, Cuculi F, Wolfrum M, Toggweiler S. Hypoattenuated Leaflet Thickening After Implantation of the ACURATE neo or the ACURATE neo2 Transcatheter Heart Valve. Am J Cardiol 2023; 200:146-152. [PMID: 37321028 DOI: 10.1016/j.amjcard.2023.05.038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/16/2023] [Revised: 04/28/2023] [Accepted: 05/21/2023] [Indexed: 06/17/2023]
Abstract
Subclinical leaflet thrombosis, identified as hypoattenuated leaflet thickening (HALT) on cardiac computed tomography scan, has been observed after transcatheter aortic valve replacement (TAVR). However, data on HALT after the implant of the supra-annular ACURATE neo/neo2 prosthesis are limited. This study aimed to determine the prevalence and risk factors for the development of HALT after TAVR with the ACURATE neo/neo2. A total of 50 patients who received the ACURATE neo/neo2 prosthesis were prospectively enrolled. Patients underwent a contrast-enhanced multidetector row cardiac computed tomography scan at before, after, and 6 months after TAVR. At the 6-month follow-up, HALT was detected in 16% (8 of 50 patients). These patients had a lower implant depth of the transcatheter heart valve (8 ± 2 mm vs 5 ± 2 mm, p = 0.001), less calcified native valve leaflets, a better expansion of the frame at the level of the left ventricular outflow tract, and were less often hypertensive. Thrombosis of the sinus of Valsalva occurred in 18% (9/50). There was no difference in the anticoagulation regimen between patients with and without thrombotic findings. In conclusion, HALT was present in 16% of patients at 6 months follow-up, patients presenting with HALT had a lower implant depth of the transcatheter heart valve, and HALT was detected in patients on oral anticoagulation therapy.
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Affiliation(s)
- Stephanie Brunner
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Miriam Brinkert
- Department of Cardiology, Kantonsspital Aarau, Aarau, Switzerland
| | - Federico Moccetti
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Lucca Loretz
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Jürgen Fornaro
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Simon F Stämpfli
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | | | - Matthias Bossard
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Ralf Buhmann
- Department of Radiology, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Florim Cuculi
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Mathias Wolfrum
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Stefan Toggweiler
- Cardiology Division, Heart Center Lucerne, Luzerner Kantonsspital, Lucerne, Switzerland.
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10
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Prandi FR, Niv Granot Y, Margonato D, Belli M, Illuminato F, Vinayak M, Barillà F, Romeo F, Tang GHL, Sharma S, Kini A, Lerakis S. Coronary Obstruction during Valve-in-Valve Transcatheter Aortic Valve Replacement: Pre-Procedural Risk Evaluation, Intra-Procedural Monitoring, and Follow-Up. J Cardiovasc Dev Dis 2023; 10:jcdd10050187. [PMID: 37233154 DOI: 10.3390/jcdd10050187] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2023] [Revised: 04/20/2023] [Accepted: 04/21/2023] [Indexed: 05/27/2023] Open
Abstract
Valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) is emerging as an effective treatment for patients with symptomatically failing bioprosthetic valves and a high prohibitive surgical risk; a longer life expectancy has led to a higher demand for these valve reinterventions due to the increased possibilities of outliving the bioprosthetic valve's durability. Coronary obstruction is the most feared complication of valve-in-valve (ViV) TAVR; it is a rare but life-threatening complication and occurs most frequently at the left coronary artery ostium. Accurate pre-procedural planning, mainly based on cardiac computed tomography, is crucial to determining the feasibility of a ViV TAVR and to assessing the anticipated risk of a coronary obstruction and the eventual need for coronary protection measures. Intraprocedurally, the aortic root and a selective coronary angiography are useful for evaluating the anatomic relationship between the aortic valve and coronary ostia; transesophageal echocardiographic real-time monitoring of the coronary flow with a color Doppler and pulsed-wave Doppler is a valuable tool that allows for a determination of real-time coronary patency and the detection of asymptomatic coronary obstructions. Because of the risk of developing a delayed coronary obstruction, the close postprocedural monitoring of patients at a high risk of developing coronary obstructions is advisable. CT simulations of ViV TAVR, 3D printing models, and fusion imaging represent the future directions that may help provide a personalized lifetime strategy and tailored approach for each patient, potentially minimizing complications and improving outcomes.
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Affiliation(s)
- Francesca Romana Prandi
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Yoav Niv Granot
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Davide Margonato
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Martina Belli
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
- Cardiovascular Imaging Unit, San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Federica Illuminato
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Manish Vinayak
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Francesco Barillà
- Division of Cardiology, Department of Systems Medicine, Tor Vergata University, 00133 Rome, Italy
| | - Francesco Romeo
- Faculty of Medicine, Unicamillus-Saint Camillus International University of Health and Medical Sciences, 00131 Rome, Italy
| | - Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Samin Sharma
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Annapoorna Kini
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
| | - Stamatios Lerakis
- Division of Cardiology, Mount Sinai Hospital, Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA
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11
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Khodaei S, Garber L, Bauer J, Emadi A, Keshavarz-Motamed Z. Long-term prognostic impact of paravalvular leakage on coronary artery disease requires patient-specific quantification of hemodynamics. Sci Rep 2022; 12:21357. [PMID: 36494362 PMCID: PMC9734172 DOI: 10.1038/s41598-022-21104-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 09/22/2022] [Indexed: 12/13/2022] Open
Abstract
Transcatheter aortic valve replacement (TAVR) is a frequently used minimally invasive intervention for patient with aortic stenosis across a broad risk spectrum. While coronary artery disease (CAD) is present in approximately half of TAVR candidates, correlation of post-TAVR complications such as paravalvular leakage (PVL) or misalignment with CAD are not fully understood. For this purpose, we developed a multiscale computational framework based on a patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-structure interaction model to quantify metrics of global circulatory function, metrics of global cardiac function and local cardiac fluid dynamics in 6 patients. Based on our findings, PVL limits the benefits of TAVR and restricts coronary perfusion due to the lack of sufficient coronary blood flow during diastole phase (e.g., maximum coronary flow rate reduced by 21.73%, 21.43% and 21.43% in the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) respectively (N = 6)). Moreover, PVL may increase the LV load (e.g., LV load increased by 17.57% (N = 6)) and decrease the coronary wall shear stress (e.g., maximum wall shear stress reduced by 20.62%, 21.92%, 22.28% and 25.66% in the left main coronary artery (LMCA), left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) respectively (N = 6)), which could promote atherosclerosis development through loss of the physiological flow-oriented alignment of endothelial cells. This study demonstrated that a rigorously developed personalized image-based computational framework can provide vital insights into underlying mechanics of TAVR and CAD interactions and assist in treatment planning and patient risk stratification in patients.
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Affiliation(s)
- Seyedvahid Khodaei
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - Louis Garber
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada
| | - Julia Bauer
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada
| | - Ali Emadi
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada
- Department of Electrical and Computer Engineering, McMaster University, Hamilton, ON, Canada
| | - Zahra Keshavarz-Motamed
- Department of Mechanical Engineering (Mail to JHE-310), McMaster University, Hamilton, ON, L8S 4L7, Canada.
- School of Biomedical Engineering, McMaster University, Hamilton, ON, Canada.
- School of Computational Science and Engineering, McMaster University, Hamilton, ON, Canada.
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12
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Koren O, Patel V, Naami R, Naami E, Nagasaka T, Shechter A, Natanzon SS, Kohan S, Allison Z, Lerner A, Cheng DE, Chakravarty T, Nakamura M, Cheng W, Jilaihawi H, Makkar RR. New adverse coronary events in valve-in-valve TAVR and native TAVR—A 2-year matched cohort. Front Cardiovasc Med 2022; 9:1004103. [PMID: 36211543 PMCID: PMC9532571 DOI: 10.3389/fcvm.2022.1004103] [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: 07/26/2022] [Accepted: 08/29/2022] [Indexed: 12/05/2022] Open
Abstract
Objective To assess the incidence of new adverse coronary events (NACE) following transcatheter aortic valve replacement (TAVR) and valve-in-valve TAVR (ViV-TAVR). Background ViV-TAVR is an accepted treatment for degenerative prostheses among patients with high surgical-risk. TAVR studies have suggested an increased risk of coronary artery obstruction and flow stasis causing thrombus formation. Whether contemporary ViV-TAVR is associated with higher rate of coronary events compared to TAVR is unknown. Methods We used data from 1,224 TAVR patients between 2016 and 2021. We propensity-matched patients following ViV-TAVR and TAVR by significant predictors to overcome confounders in patients' baseline characteristics and procedural factors. Results The matched population included 129 patients in each group. In line with prior reports, there was a higher in-hospital coronary artery obstruction rate with ViV-TAVR (3.1 vs. 1.6%; p = 0.23). Despite this, 2-year cumulative NACE rates were similar between groups (4.7 vs. 6.2%, respectively, p = 0.79), with no difference between its components: myocardial infarction (MI) (p = 0.210), unplanned coronary catheterization (p = 0.477), or coronary artery bypass grafting (CABG) (p = 0.998). Moreover, hypoattenuated leaflets thickening (HALT) at 30-day CT was observed in nearly a quarter of the patients with no difference between groups (23.9 vs. 23.1%, HR 1.02, 95% CI 0.50–1.28, p = 0.872). The progression rate of the coronary artery calcium score (CACS), assessed in a third of patients, was similar between groups (p log-rank = 0.468, 95% CI 0.12–1.24). Low coronary artery height was an unfavorable predictor for in-hospital coronary obstruction and 2-year NACE rate (HR 1.20 and HR 1.25, p = 0.001 and p < 0.0001, respectively). Conclusion At 2-year follow-up, ViV-TAVR was not associated with a higher rate of myocardial infarction, unplanned catheterization, coronary artery bypass grafting, or hypoattenuated leaflet thickening.
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Affiliation(s)
- Ofir Koren
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
- Bruce Rappaport Faculty of Medicine, Technion Israel Institute of Technology, Haifa, Israel
| | - Vivek Patel
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Robert Naami
- Internal Medicine, University Hospitals Cleveland Medical Center, Case Western Reserve University School of Medicine, Cleveland, OH, United States
| | - Edmund Naami
- School of Medicine, University of Illinois, Chicago, IL, United States
| | - Takashi Nagasaka
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
- The Department of Cardiology, Gunma University Hospital, Gunma, Japan
| | - Alon Shechter
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Siamak Kohan
- Internal Medicine, Kaiser Permanente Medical Center, Los Angeles, CA, United States
| | - Zev Allison
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Addee Lerner
- David Geffen School of Medicine, University of California (UCLA), Los Angeles, Los Angeles, CA, United States
| | - Daniel Eugene Cheng
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Tarun Chakravarty
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Mamoo Nakamura
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Wen Cheng
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
| | - Hasan Jilaihawi
- Heart Valve Center, NYU Langone Health, New York, NY, United States
| | - Raj R. Makkar
- Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, United States
- *Correspondence: Raj R. Makkar
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13
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Raghav V, Midha P, Sharma R, Babaliaros V, Yoganathan A. Transcatheter aortic valve thrombosis: a review of potential mechanisms. J R Soc Interface 2021; 18:20210599. [PMID: 34814733 DOI: 10.1098/rsif.2021.0599] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Transcatheter aortic valve (TAV) thrombosis has been recognized as a significant problem that sometimes occurs as early as within 30 days after valve implantation, leading to increased concerns of stroke and long-term valve durability. In this article, a critical summary of the relevant literature on identifying potential mechanisms of TAV thrombosis from the perspective of the well-known Virchow's triad, which comprises blood flow, foreign materials and blood biochemistry, is presented. Blood flow mechanisms have been the primary focus thus far, with a general consensus on the flow mechanisms with respect to haemodynamic conditions, the influence of TAV placement and expansion and the influence of coronary flow. Less attention has been paid to the influence of blood biochemistry and foreign materials (and related endothelial damage), with little consensus among studies with regards to platelet and/or microparticle levels post-TAV implantation. Finally, we discuss the future outlook for research with unanswered scientific questions.
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Affiliation(s)
- Vrishank Raghav
- Department of Aerospace Engineering, Auburn University, Auburn, AL, USA
| | - Prem Midha
- Abbott Laboratories, Abbott Park, IL, USA
| | - Rahul Sharma
- Interventional Cardiology, Cardiovascular Medicine Faculty, Stanford University, Stanford, CA, USA
| | - Vasilis Babaliaros
- Division of Cardiology, Emory Structural Heart and Valve Center, Emory University, Atlanta, GA, USA
| | - Ajit Yoganathan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Atlanta, GA, USA
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14
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Vogl BJ, Niemi NR, Griffiths LG, Alkhouli MA, Hatoum H. Impact of calcific aortic valve disease on valve mechanics. Biomech Model Mechanobiol 2021; 21:55-77. [PMID: 34687365 DOI: 10.1007/s10237-021-01527-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2021] [Accepted: 10/07/2021] [Indexed: 10/20/2022]
Abstract
The aortic valve is a highly dynamic structure characterized by a transvalvular flow that is unsteady, pulsatile, and characterized by episodes of forward and reverse flow patterns. Calcific aortic valve disease (CAVD) resulting in compromised valve function and increased pressure overload on the ventricle potentially leading to heart failure if untreated, is the most predominant valve disease. CAVD is a multi-factorial disease involving molecular, tissue and mechanical interactions. In this review, we aim at recapitulating the biomechanical loads on the aortic valve, summarizing the current and most recent research in the field in vitro, in-silico, and in vivo, and offering a clinical perspective on current strategies adopted to mitigate or approach CAVD.
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Affiliation(s)
- Brennan J Vogl
- Biomedical Engineering Department, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA
| | - Nicholas R Niemi
- Biomedical Engineering Department, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA
| | - Leigh G Griffiths
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, MN, USA
| | | | - Hoda Hatoum
- Biomedical Engineering Department, Michigan Technological University, 1400 Townsend Dr, Houghton, MI, 49931, USA. .,Health Research Institute, Michigan Technological University, Houghton, MI, USA. .,Center of Biocomputing and Digital Health, Michigan Technological University, Houghton, MI, USA.
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