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Whiting R, Sander E, Conway C, Vaughan TJ. In silico modelling of aortic valve implants - predicting in vitro performance using finite element analysis. J Med Eng Technol 2022; 46:220-230. [PMID: 35072595 DOI: 10.1080/03091902.2022.2026506] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
The competing structural and hemodynamic considerations in valve design generally require a large amount of in vitro hydrodynamic and durability testing during development, often resulting in inefficient "trial-and-error" prototyping. While in silico modelling through finite element analysis (FEA) has been widely used to inform valve design by optimising structural performance, few studies have exploited the potential insight FEA could provide into critical hemodynamic performance characteristics of the valve. The objective of this study is to demonstrate the potential of FEA to predict the hydrodynamic performance of tri-leaflet aortic valve implants obtained during development through in vitro testing. Several variations of tri-leaflet aortic valves were designed and manufactured using a synthetic polymer and hydrodynamic testing carried out using a pulsatile flow rig according to ISO 5840, with bulk hydrodynamic parameters measured. In silico models were developed in tandem and suitable surrogate measures were investigated as predictors of the hydrodynamic parameters. Through regression analysis, the in silico parameters of leaflet coaptation area, geometric orifice area and opening pressure were found to be suitable indicators of experimental in vitro hydrodynamic parameters: regurgitant fraction, effective orifice area and transvalvular pressure drop performance, respectively.
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Affiliation(s)
- Robert Whiting
- Biomechanics Research Centre (BMEC), Biomedical Engineering, School of Engineering, National University of Ireland Galway, Galway, Ireland
| | - Elizabeth Sander
- Cardiovascular Research and Innovation Centre, School of Medicine, National University of Ireland Galway, Galway, Ireland
| | - Claire Conway
- Tissue Engineering Research Group (TERG), Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland
| | - Ted J Vaughan
- Biomechanics Research Centre (BMEC), Biomedical Engineering, School of Engineering, National University of Ireland Galway, Galway, Ireland
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Wiggins LM, Kumar SR, Starnes VA. The Ross Procedure in Children: The Gold Standard? Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu 2021; 24:62-66. [PMID: 34116784 DOI: 10.1053/j.pcsu.2021.03.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2020] [Revised: 03/04/2021] [Accepted: 03/09/2021] [Indexed: 11/11/2022]
Abstract
The management of aortic valve disease in the pediatric population is complex and requires an individualized approach and opportune application of techniques focused on each individual patient's specific anatomy, pathology, and clinical presentation. Though some patients may require variations in the approach to management, the ultimate goal should be to perform a Ross procedure when aortic valve replacement is indicated.
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Affiliation(s)
- Luke M Wiggins
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California; Heart Institute, Children's Hospital Los Angeles, Los Angeles, California.
| | - S Ram Kumar
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California; Heart Institute, Children's Hospital Los Angeles, Los Angeles, California
| | - Vaughn A Starnes
- Division of Cardiac Surgery, Department of Surgery, Keck School of Medicine of the University of Southern California, Los Angeles, California; Heart Institute, Children's Hospital Los Angeles, Los Angeles, California
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Milewski RK, Habertheuer A, Bavaria JE, Fuller S, Desai ND, Szeto WY, Korutla V, Vallabhajosyula P. Selection of prosthetic aortic valve and root replacement in patients younger than age 30 years. J Thorac Cardiovasc Surg 2019; 157:714-725. [DOI: 10.1016/j.jtcvs.2018.06.102] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/09/2017] [Revised: 05/22/2018] [Accepted: 06/11/2018] [Indexed: 10/27/2022]
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Myers PO, Mokashi SA, Horgan E, Borisuk M, Mayer JE, del Nido PJ, Baird CW. Outcomes after mechanical aortic valve replacement in children and young adults with congenital heart disease. J Thorac Cardiovasc Surg 2019; 157:329-340. [DOI: 10.1016/j.jtcvs.2018.08.077] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2015] [Revised: 04/03/2018] [Accepted: 08/01/2018] [Indexed: 11/30/2022]
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Al-Radi OO. Options for aortic valve replacement in children and young adults: “Okay, doctor, but which one do you think I should choose?”. J Thorac Cardiovasc Surg 2016; 151:153-4. [DOI: 10.1016/j.jtcvs.2015.10.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/01/2015] [Accepted: 10/02/2015] [Indexed: 11/29/2022]
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Kheradvar A, Groves EM, Goergen CJ, Alavi SH, Tranquillo R, Simmons CA, Dasi LP, Grande-Allen KJ, Mofrad MRK, Falahatpisheh A, Griffith B, Baaijens F, Little SH, Canic S. Emerging Trends in Heart Valve Engineering: Part II. Novel and Standard Technologies for Aortic Valve Replacement. Ann Biomed Eng 2014; 43:844-57. [DOI: 10.1007/s10439-014-1191-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2014] [Accepted: 11/13/2014] [Indexed: 11/29/2022]
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Roscani MG, Polegato BF, Minamoto SET, Lousada APM, Minicucci M, Azevedo P, Matsubara LS, Matsubara BB. Left ventricular sphericity index predicts systolic dysfunction in rats with experimental aortic regurgitation. J Appl Physiol (1985) 2014; 116:1259-62. [DOI: 10.1152/japplphysiol.00840.2013] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Although an increased left ventricular (LV) diastolic diameter (DD) and a decreased ejection fraction have been used as markers for the surgical replacement of an insufficient aortic valve, these signals may be observed when irreversible myocardium damage has already occurred. The aim of this study was to determine whether change in LV geometry predicts systolic dysfunction in experimental aortic regurgitation. Male Wistar rats underwent surgical acute aorta regurgitation (aorta regurgitation group; n = 23) or a sham operation (sham group; n = 12). After the procedure, serial transthoracic echocardiograms were performed at 1, 4, 8, and 16 wk. At the end of protocol, the LV, lungs, and liver were dissected and weighed. During the follow-up, no animal developed overt heart failure. There was a correlation between the LV sphericity index and reduced fractional shortening ( P < 0.001) over time. A multiple regression model showed that the LVDD-sphericity index association at 8 wk was a better predictor of decreased fractional shortening at week 16 ( R2 = 0.50; P < 0.001) than was the LVDD alone ( R2 = 0.39; P = 0.001). LV geometry associated with increased LVDD improved the prediction of systolic dysfunction in experimental aortic regurgitation.
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Affiliation(s)
- Meliza Goi Roscani
- Department of Internal Medicine, Botucatu Medical School, University of Estadual Paulista (Universidade Estadual Paulista “Júlio de Mesquita Filho”), São Paulo, Brazil
| | - Bertha Fulan Polegato
- Department of Internal Medicine, Botucatu Medical School, University of Estadual Paulista (Universidade Estadual Paulista “Júlio de Mesquita Filho”), São Paulo, Brazil
| | - Suzana Erico Tanni Minamoto
- Department of Internal Medicine, Botucatu Medical School, University of Estadual Paulista (Universidade Estadual Paulista “Júlio de Mesquita Filho”), São Paulo, Brazil
| | - Ana Paula Mena Lousada
- Department of Internal Medicine, Botucatu Medical School, University of Estadual Paulista (Universidade Estadual Paulista “Júlio de Mesquita Filho”), São Paulo, Brazil
| | - Marcos Minicucci
- Department of Internal Medicine, Botucatu Medical School, University of Estadual Paulista (Universidade Estadual Paulista “Júlio de Mesquita Filho”), São Paulo, Brazil
| | - Paula Azevedo
- Department of Internal Medicine, Botucatu Medical School, University of Estadual Paulista (Universidade Estadual Paulista “Júlio de Mesquita Filho”), São Paulo, Brazil
| | - Luiz Shiguero Matsubara
- Department of Internal Medicine, Botucatu Medical School, University of Estadual Paulista (Universidade Estadual Paulista “Júlio de Mesquita Filho”), São Paulo, Brazil
| | - Beatriz Bojikian Matsubara
- Department of Internal Medicine, Botucatu Medical School, University of Estadual Paulista (Universidade Estadual Paulista “Júlio de Mesquita Filho”), São Paulo, Brazil
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