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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] [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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2
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Catalano C, Crascì F, Puleo S, Scuoppo R, Pasta S, Raffa GM. Computational fluid dynamics in cardiac surgery and perfusion: A review. Perfusion 2024:2676591241239277. [PMID: 38850015 DOI: 10.1177/02676591241239277] [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: 06/09/2024]
Abstract
Cardiovascular diseases persist as a leading cause of mortality and morbidity, despite significant advances in diagnostic and surgical approaches. Computational Fluid Dynamics (CFD) represents a branch of fluid mechanics widely used in industrial engineering but is increasingly applied to the cardiovascular system. This review delves into the transformative potential for simulating cardiac surgery procedures and perfusion systems, providing an in-depth examination of the state-of-the-art in cardiovascular CFD modeling. The study first describes the rationale for CFD modeling and later focuses on the latest advances in heart valve surgery, transcatheter heart valve replacement, aortic aneurysms, and extracorporeal membrane oxygenation. The review underscores the role of CFD in better understanding physiopathology and its clinical relevance, as well as the profound impact of hemodynamic stimuli on patient outcomes. By integrating computational methods with advanced imaging techniques, CFD establishes a quantitative framework for understanding the intricacies of the cardiac field, providing valuable insights into disease progression and treatment strategies. As technology advances, the evolving synergy between computational simulations and clinical interventions is poised to revolutionize cardiovascular care. This collaboration sets the stage for more personalized and effective therapeutic strategies. With its potential to enhance our understanding of cardiac pathologies, CFD stands as a promising tool for improving patient outcomes in the dynamic landscape of cardiovascular medicine.
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Affiliation(s)
- Chiara Catalano
- Department of Engineering, Università degli Studi di Palermo, Palermo, Italy
| | - Fabrizio Crascì
- Department of Engineering, Università degli Studi di Palermo, Palermo, Italy
- Department of Research, IRCCS-ISMETT, Palermo, Italy
| | - Silvia Puleo
- Department of Engineering, Università degli Studi di Palermo, Palermo, Italy
| | - Roberta Scuoppo
- Department of Engineering, Università degli Studi di Palermo, Palermo, Italy
| | - Salvatore Pasta
- Department of Engineering, Università degli Studi di Palermo, Palermo, Italy
- Department of Research, IRCCS-ISMETT, Palermo, Italy
| | - Giuseppe M Raffa
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
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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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Spanjaards M, Borowski F, Supp L, Ubachs R, Lavezzo V, van der Sluis O. A fast in silico model for preoperative risk assessment of paravalvular leakage. Biomech Model Mechanobiol 2024; 23:959-985. [PMID: 38341820 PMCID: PMC11101555 DOI: 10.1007/s10237-024-01816-8] [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: 09/20/2023] [Accepted: 01/01/2024] [Indexed: 02/13/2024]
Abstract
In silico simulations can be used to evaluate and optimize the safety, quality, efficacy and applicability of medical devices. Furthermore, in silico modeling is a powerful tool in therapy planning to optimally tailor treatment for each patient. For this purpose, a workflow to perform fast preoperative risk assessment of paravalvular leakage (PVL) after transcatheter aortic valve replacement (TAVR) is presented in this paper. To this end, a novel, efficient method is introduced to calculate the regurgitant volume in a simplified, but sufficiently accurate manner. A proof of concept of the method is obtained by comparison of the calculated results with results obtained from in vitro experiments. Furthermore, computational fluid dynamics (CFD) simulations are used to validate more complex stenosis scenarios. Comparing the simplified leakage model to CFD simulations reveals its potential for procedure planning and qualitative preoperative risk assessment of PVL. Finally, a 3D device deployment model and the efficient leakage model are combined to showcase the application of the presented leakage model, by studying the effect of stent size and the degree of stenosis on the regurgitant volume. The presented leakage model is also used to visualize the leakage path. To generalize the leakage model to a wide range of clinical applications, further validation on a large cohort of patients is needed to validate the accuracy of the model's prediction under various patient-specific conditions.
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Affiliation(s)
- Michelle Spanjaards
- Philips Innovation and Strategy, High Tech Campus 34, Eindhoven, The Netherlands
| | - Finja Borowski
- Institute for Implant Technology and Biomaterials e.V., Friedrich-Barnewitz-Str. 4, Rostock-Warnemünde, Germany
| | - Laura Supp
- Institute for Implant Technology and Biomaterials e.V., Friedrich-Barnewitz-Str. 4, Rostock-Warnemünde, Germany
| | - René Ubachs
- Philips Innovation and Strategy, High Tech Campus 34, Eindhoven, The Netherlands
| | - Valentina Lavezzo
- Philips Innovation and Strategy, High Tech Campus 34, Eindhoven, The Netherlands
| | - Olaf van der Sluis
- Philips Innovation and Strategy, High Tech Campus 34, Eindhoven, The Netherlands.
- Eindhoven University of Technology, Groene Loper 15, Eindhoven, The Netherlands.
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Ramella A, Lissoni V, Bridio S, Rodriguez Matas JF, Trimarchi S, Grossi B, Stefanini GG, Migliavacca F, Luraghi G. On the necessity to include arterial pre-stress in patient-specific simulations of minimally invasive procedures. Biomech Model Mechanobiol 2024; 23:525-537. [PMID: 38063955 PMCID: PMC10963513 DOI: 10.1007/s10237-023-01789-0] [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: 06/27/2023] [Accepted: 10/27/2023] [Indexed: 03/26/2024]
Abstract
Transcatheter aortic valve implantation (TAVI) and thoracic endovascular aortic repair (TEVAR) are minimally invasive procedures for treating aortic valves and diseases. Finite element simulations have proven to be valuable tools in predicting device-related complications. In the literature, the inclusion of aortic pre-stress has not been widely investigated. It plays a crucial role in determining the biomechanical response of the vessel and the device-tissue interaction. This study aims at demonstrating how and when to include the aortic pre-stress in patient-specific TAVI and TEVAR simulations. A percutaneous aortic valve and a stent-graft were implanted in aortic models reconstructed from patient-specific CT scans. Two scenarios for each patient were compared, i.e., including and neglecting the wall pre-stress. The neglection of pre-stress underestimates the contact pressure of 48% and 55%, the aorta stresses of 162% and 157%, the aorta strains of 77% and 21% for TAVI and TEVAR models, respectively. The stent stresses are higher than 48% with the pre-stressed aorta in TAVI simulations; while, similar results are obtained in TEVAR cases. The distance between the device and the aorta is similar with and without pre-stress. The inclusion of the aortic wall pre-stress has the capability to give a better representation of the biomechanical behavior of the arterial tissues and the implanted device. It is suggested to include this effect in patient-specific simulations replicating the procedures.
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Affiliation(s)
- Anna Ramella
- Computational Biomechanics Laboratory - LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Vittorio Lissoni
- Computational Biomechanics Laboratory - LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Sara Bridio
- Computational Biomechanics Laboratory - LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Jose Felix Rodriguez Matas
- Computational Biomechanics Laboratory - LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Santi Trimarchi
- Section of Vascular Surgery, Cardio Thoracic Vascular Department, Foundation IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Francesco Sforza 35, Milan, Italy
- Department of Clinical Sciences and Community Health, University of Milan, Via Della Commenda 19, 20122, Milan, Italy
| | - Benedetta Grossi
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
| | - Giulio G Stefanini
- Department of Biomedical Sciences, Humanitas University, Via Rita Levi Montalcini 4, 20072, Pieve Emanuele, Milan, Italy
- IRCCS Humanitas Research Hospital, Via Alessandro Manzoni 56, 20089, Rozzano, Milan, Italy
| | - Francesco Migliavacca
- Computational Biomechanics Laboratory - LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Giulia Luraghi
- Computational Biomechanics Laboratory - LaBS, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta', Politecnico di Milano, Piazza L. da Vinci 32, 20133, Milan, Italy.
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Verstraeten S, Hoeijmakers M, Tonino P, Brüning J, Capelli C, van de Vosse F, Huberts W. Generation of synthetic aortic valve stenosis geometries for in silico trials. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2024; 40:e3778. [PMID: 37961993 DOI: 10.1002/cnm.3778] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Revised: 09/01/2023] [Accepted: 09/17/2023] [Indexed: 11/15/2023]
Abstract
In silico trials are a promising way to increase the efficiency of the development, and the time to market of cardiovascular implantable devices. The development of transcatheter aortic valve implantation (TAVI) devices, could benefit from in silico trials to overcome frequently occurring complications such as paravalvular leakage and conduction problems. To be able to perform in silico TAVI trials virtual cohorts of TAVI patients are required. In a virtual cohort, individual patients are represented by computer models that usually require patient-specific aortic valve geometries. This study aimed to develop a virtual cohort generator that generates anatomically plausible, synthetic aortic valve stenosis geometries for in silico TAVI trials and allows for the selection of specific anatomical features that influence the occurrence of complications. To build the generator, a combination of non-parametrical statistical shape modeling and sampling from a copula distribution was used. The developed virtual cohort generator successfully generated synthetic aortic valve stenosis geometries that are comparable with a real cohort, and therefore, are considered as being anatomically plausible. Furthermore, we were able to select specific anatomical features with a sensitivity of around 90%. The virtual cohort generator has the potential to be used by TAVI manufacturers to test their devices. Future work will involve including calcifications to the synthetic geometries, and applying high-fidelity fluid-structure-interaction models to perform in silico trials.
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Affiliation(s)
- Sabine Verstraeten
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | | | - Pim Tonino
- Department of Cardiology, Catharina Hospital, Eindhoven, The Netherlands
| | - Jan Brüning
- Institute of Computer-assisted Cardiovascular Medicine, Charite Universitaetsmedizin, Berlin, Germany
| | - Claudio Capelli
- Institute of Cardiovascular Science, University College London, London, UK
| | - Frans van de Vosse
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
| | - Wouter Huberts
- Department of Biomedical Engineering, Eindhoven University of Technology, Eindhoven, The Netherlands
- Department of Biomedical Engineering, CARIM School for Cardiovascular Diseases, Maastricht University, Maastricht, The Netherlands
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7
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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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Diversity, Lifestyle, Genomics, and Their Functional Role of Cochliobolus, Bipolaris, and Curvularia Species in Environmental Remediation and Plant Growth Promotion under Biotic and Abiotic Stressors. J Fungi (Basel) 2023; 9:jof9020254. [PMID: 36836368 PMCID: PMC9962790 DOI: 10.3390/jof9020254] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2022] [Revised: 01/25/2023] [Accepted: 01/27/2023] [Indexed: 02/17/2023] Open
Abstract
Cochliobolus, Bipolaris, and Curvularia genera contain various devastating plant pathogens that cause severe crop losses worldwide. The species belonging to these genera also perform a variety of diverse functions, including the remediation of environmental contaminations, beneficial phytohormone production, and maintaining their lifestyle as epiphytes, endophytes, and saprophytes. Recent research has revealed that despite their pathogenic nature, these fungi also play an intriguing role in agriculture. They act as phosphate solubilizers and produce phytohormones, such as indole acetic acid (IAA) and gibberellic acid (GAs), to accelerate the growth of various plants. Some species have also been reported to play a significant role in plant growth promotion during abiotic stresses, such as salinity stress, drought stress, heat stress, and heavy metal stress, as well as act as a biocontrol agent and a potential mycoherbicide. Similarly, these species have been reported in numerous industrial applications to produce different types of secondary metabolites and biotechnological products and possess a variety of biological properties, such as antibacterial, antileishmanial, cytotoxic, phytotoxic, and antioxidant activities. Additionally, some of the species have been utilized in the production of numerous valuable industrial enzymes and biotransformation, which has an impact on the growth of crops all over the world. However, the current literature is dispersed, and some of the key areas, such as taxonomy, phylogeny, genome sequencing, phytohormonal analysis, and diversity, are still being neglected in terms of the elucidation of its mechanisms, plant growth promotion, stress tolerance, and bioremediation. In this review, we highlighted the potential role, function, and diversity of Cochliobolus, Curvularia, and Bipolaris for improved utilization during environmental biotechnology.
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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] [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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On the Modeling of Transcatheter Therapies for the Aortic and Mitral Valves: A Review. PROSTHESIS 2022. [DOI: 10.3390/prosthesis4010011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) has become a milestone for the management of aortic stenosis in a growing number of patients who are unfavorable candidates for surgery. With the new generation of transcatheter heart valves (THV), the feasibility of transcatheter mitral valve replacement (TMVR) for degenerated mitral bioprostheses and failed annuloplasty rings has been demonstrated. In this setting, computational simulations are modernizing the preoperative planning of transcatheter heart valve interventions by predicting the outcome of the bioprosthesis interaction with the human host in a patient-specific fashion. However, computational modeling needs to carry out increasingly challenging levels including the verification and validation to obtain accurate and realistic predictions. This review aims to provide an overall assessment of the recent advances in computational modeling for TAVR and TMVR as well as gaps in the knowledge limiting model credibility and reliability.
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11
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Pietrasanta L, Zheng S, De Marinis D, Hasler D, Obrist D. Characterization of Turbulent Flow Behind a Transcatheter Aortic Valve in Different Implantation Positions. Front Cardiovasc Med 2022; 8:804565. [PMID: 35097022 PMCID: PMC8794584 DOI: 10.3389/fcvm.2021.804565] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2021] [Accepted: 12/14/2021] [Indexed: 11/21/2022] Open
Abstract
The development of turbulence after transcatheter aortic valve (TAV) implantation may have detrimental effects on the long-term performance and durability of the valves. The characterization of turbulent flow generated after TAV implantation can provide fundamental insights to enhance implantation techniques. A self-expandable TAV was tested in a pulse replicator and the three-dimensional flow field was extracted by means of tomographic particle image velocimetry. The valve was fixed inside a silicone phantom mimicking the aortic root and the flow field was studied for two different supra-annular axial positions at peak systole. Fluctuating velocities and turbulent kinetic energy were compared between the two implantations. Velocity spectra were derived at different spatial positions in the turbulent wakes to characterize the turbulent flow. The valve presented similar overall flow topology but approximately 8% higher turbulent intensity in the lower implantation. In this configuration, axial views of the valve revealed smaller opening area and more corrugated leaflets during systole, as well as more accentuated pinwheeling during diastole. The difference arose from a lower degree of expansion of the TAV's stent inside the aortic lumen. These results suggest that the degree of expansion of the TAV in-situ is related to the onset of turbulence and that a smaller and less regular opening area might introduce flow instabilities that could be detrimental for the long-term performance of the valve. The present study highlights how implantation mismatches may affect the structure and intensity of the turbulent flow in the aortic root.
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Affiliation(s)
- Leonardo Pietrasanta
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- *Correspondence: Leonardo Pietrasanta
| | - Shaokai Zheng
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Dario De Marinis
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
- Dipartimento di Meccanica Matematica e Management, Centro di Eccellenza in Meccanica Computazionale, Politecnico di Bari, Bari, Italy
| | - David Hasler
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
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Azriff Basri A, Zuber M, Illyani Basri E, Shukri Zakaria M, Fazli Abd Aziz A, Tamagawa M, Arifin Ahmad K. Fluid-Structure Interaction in Problems of Patient Specific Transcatheter Aortic Valve Implantation with and Without Paravalvular Leakage Complication. FLUID DYNAMICS & MATERIALS PROCESSING 2021; 17:531-553. [DOI: 10.32604/fdmp.2021.010925] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 09/02/2023]
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13
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Luraghi G, Rodriguez Matas JF, Migliavacca F. In silico approaches for transcatheter aortic valve replacement inspection. Expert Rev Cardiovasc Ther 2020; 19:61-70. [PMID: 33201738 DOI: 10.1080/14779072.2021.1850265] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
Introduction: Increasing applications of transcatheter aortic valve replacement (TAVR) to treat high- or medium-risk patients with aortic diseases have been proposed in recent years. Despite its increasing use, many influential factors are still to be understood. Furthermore, innovative applications of TAVR such as in bicuspid aortic valves or in low-risk patients are emerging in clinical use. Numerical analyses are increasingly used to reproduce clinical treatments. The future trends in this area are foreseen for in silico trials and personalized medicine. Areas covered: This review paper analyzes the recent years (Jan 2018 - Aug 2020) of in silico studies simulating the behavior of transcatheter aortic valves with emphasis on the addressed clinical question and the used modeling strategies. The manuscripts are firstly classified based on their clinical hypothesis. A second classification is based on the adopted modeling approach in terms of patient domain, device modeling, and inclusion or exclusion of the fluid domain. Expert opinion: The TAVR can be virtually performed in numerous vessel geometries and with different devices. This versatility allows a rapid evaluation of the feasibility of different implantation approaches for specific patients, and patient populations, resulting in faster and safer introduction or optimization of new treatments or devices.
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Affiliation(s)
- Giulia Luraghi
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta, Politecnico di Milano , Milan, Italy
| | - Jose Felix Rodriguez Matas
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta, Politecnico di Milano , Milan, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta, Politecnico di Milano , Milan, Italy
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