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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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Liu K, Wu K, Shen J, Meng F, Nappi F, Alfonso F, Wang S, Zheng S, Zhang H. Transcatheter aortic valve replacement in the treatment of bicuspid aortic stenosis with "down-size" interventional valves: procedural and mid-term follow-up. J Thorac Dis 2024; 16:593-603. [PMID: 38410558 PMCID: PMC10894397 DOI: 10.21037/jtd-23-1885] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Accepted: 01/16/2024] [Indexed: 02/28/2024]
Abstract
Background Due to the influence of anatomical structure, replacing the bicuspid valve using transcatheter aortic valve replacement (TAVR) would increase the risk of perivalvular leakage and conduction block, affecting the hemodynamic effect of the interventional valve. In this study, for bicuspid and tricuspid valves, we implemented different valve selection strategies to explore the safety and effectiveness of TAVR in the treatment of bicuspid aortic stenosis with "down-size" interventional valves using the VenusA-valve system. Methods The operation was performed with the VenusA-valve via transfemoral approach. The selected valves were appropriately sized based on the results of transthoracic echocardiography (TTE), contrast-enhanced computed tomography (CT), and the morphology of intraoperative pre-dilation balloons. For tricuspid valve cases, the VenusA valve is usually larger than the annulus diameter, whereas the "down-size" approach was adopted for bicuspid aortic valve (BAV) cases. The shape of the pre-dilation balloon allowed further sizing of the annulus diameter by the degree of lumbar constriction of the balloon, aiding in intervention valve size selection, particularly in cases of BAVs. Results A total of 65 patients underwent TAVR for aortic stenosis with VenusA-valve systems. Of these, 29 cases had a BAV and 36 cases had a tricuspid aortic valve (TAV). The distribution of VenusA-valve sizes differed between TAV and BAV cases (P=0.007). Furthermore, there was a significant decrease in the average mean gradient in TAV patients from 54.7 to 12.2 mmHg (P<0.001), and in BAV patients from 61.6 to 14.3 mmHg (P<0.001). The percentage of paravalvular leakage greater than mild was 6.90% in the BAVs and 5.56% in the TAVs at procedural outcomes (P=0.955). The mean follow-up period was 22.23 months (range, 12 to 39 months). The proportion of New York Heart Association (NYHA) class III/IV decreased from 78.5% preoperatively to 11.3% at the last follow-up (P<0.001). A total of 27 patients with TAV and 19 patients with BAV underwent TTE at 1-year follow-up after operation. There was no significant contrast in the average pressure difference between TAVs and BAVs at 1-year follow-up (11.9 vs. 14.3 mmHg, P=0.18). Conclusions The VenusA-valve for TAVR produced positive clinical outcomes and valve functionality in both BAVs and TAVs. In the case of BAVs, selecting a smaller interventional valve size was deemed viable.
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Affiliation(s)
- Kun Liu
- Department of Cardiac Surgery, Cardiovascular Medical Center, the University of Hong Kong-Shenzhen Hospital, Shenzhen, China
| | - Kaisheng Wu
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Jinglun Shen
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Fei Meng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, Saint-Denis, France
| | - Fernando Alfonso
- Department of Cardiology, Hospital Universitario de La Princesa, Universidad Autónoma de Madrid, CIBERCV, IIS-IP, Madrid, Spain
| | - Shengxun Wang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Shuai Zheng
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
| | - Haibo Zhang
- Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China
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Li J, Meng Z, Yan W, Wang W, Wei L, Wang S. Computational study of the balloon dilation steps on transcatheter aortic valve replacement. Front Bioeng Biotechnol 2023; 11:1333138. [PMID: 38179134 PMCID: PMC10765527 DOI: 10.3389/fbioe.2023.1333138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2023] [Accepted: 11/30/2023] [Indexed: 01/06/2024] Open
Abstract
Balloon dilation is a commonly used assistant method in transcatheter aortic valve replacement (TAVR) and plays an important role during valve implantation procedure. The balloon dilation steps need to be fully considered in TAVR numerical simulations. This study aims to establish a TAVR simulation procedure with two different balloon dilation steps to analyze the impact of balloon dilation on the results of TAVR implantation. Two cases of aortic stenosis were constructed based on medical images. An implantation simulation procedure with self-expandable valve was established, and multiple models including different simulation steps such as balloon pre-dilation and balloon post-dilation were constructed to compare the different effects on vascular stress, stent morphology and paravalvular leakage. Results show that balloon pre-dilation of TAVR makes less impact on post-operative outcomes, while post-dilation can effectively improve the implantation morphology of the stent, which is beneficial to the function and durability of the valve. It can effectively improve the adhesion of the stent and reduce the paravalvular leakage volume more than 30% after implantation. However, balloon post-dilation may also lead to about 20% or more increased stress on the aorta and increase the risk of damage. The balloon dilation makes an important impact on the TAVR outcomes. Balloon dilation needs to be fully considered during pre-operative analysis to obtain a better clinical result.
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Affiliation(s)
- Jianming Li
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Zhuangyuan Meng
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
| | - Wentao Yan
- Shanghai Inspection and Research Institute for Medical Devices, Shanghai, China
| | - Wenshuo Wang
- Department of Cardiac Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Lai Wei
- Department of Cardiac Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China
| | - Shengzhang Wang
- Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China
- Academy for Engineering and Technology, Institute of Biomedical Engineering Technology, Fudan University, Shanghai, China
- Zhuhai Fudan Innovation Institute, Zhuhai, China
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Crascì F, Cannata S, Gentile G, Gandolfo C, Pasta S. Biomechanical performance of the Bicaval Transcatheter System for the treatment of severe tricuspid regurgitation. Front Bioeng Biotechnol 2023; 11:1179774. [PMID: 37274165 PMCID: PMC10234501 DOI: 10.3389/fbioe.2023.1179774] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2023] [Accepted: 05/09/2023] [Indexed: 06/06/2023] Open
Abstract
Introduction: Tricuspid regurgitation (TR) is a relatively common valvular disease, which can result from structural abnormalities of any anatomic part of the tricuspid valve. Severe TR is linked to congestive heart failure and hemodynamic impairment, resulting in high mortality when repaired by elective surgery. This study was undertaken to quantify the structural and hemodynamic performance of the novel Transcatheter Bicaval Valves System (TricValve) percutaneously implanted in the superior vena cava (SVC) and inferior vena cava (IVC) of two patients with severe TR and venous congestion. Methods: After developing the SVC and IVC device models, the contact pressure exerted on the vena cava wall was obtained by computational analysis. Both smoothed-particle hydrodynamics (SPH) and computational fluid dynamics were carried out to quantify caval reflux in the right atrium and the pressure field of pre- and post-TricValve scenarios, respectively. Results: Analysis of contact pressure highlighted the main anchoring area of the SVC device occurring near the SVC device belly, while the IVC device exerted pronounced forces in the device's proximal and distal parts. SPH-related flow velocities revealed the absence of caval reflux, and a decrease in time-averaged pressure was observed near the SVC and IVC after TricValve implantation. Discussion: Findings demonstrated the potential of computational tools for enhancing our understanding of the biomechanical performance of structural tricuspid valve interventions and improving the way we design next-generation transcatheter therapies to treat the tricuspid valve with heterotopic caval valve implantation.
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Affiliation(s)
- Fabrizio Crascì
- Department of Engineering, Università degli Studi di Palermo, Palermo, Italy
- Department of Research, IRCCS-ISMETT, Palermo, Italy
| | - Stefano Cannata
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Giovanni Gentile
- Radiology Unit, Department of Diagnostic and Therapeutic Services, IRCCS-ISMETT, Palermo, Italy
| | - Caterina Gandolfo
- Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy
| | - Salvatore Pasta
- Department of Engineering, Università degli Studi di Palermo, Palermo, Italy
- Department of Research, IRCCS-ISMETT, Palermo, Italy
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González AK, Rodríguez-Reséndiz J, Gonzalez-Durán JEE, Olivares Ramírez JM, Estévez-Bén AA. Development of a Hip Joint Socket by Finite-Element-Based Analysis for Mechanical Assessment. Bioengineering (Basel) 2023; 10:bioengineering10020268. [PMID: 36829762 PMCID: PMC9952638 DOI: 10.3390/bioengineering10020268] [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: 01/09/2023] [Revised: 02/04/2023] [Accepted: 02/15/2023] [Indexed: 02/22/2023] Open
Abstract
This article evaluates a hip joint socket design by finite element method (FEM). The study was based on the needs and characteristics of a patient with an oncological amputation; however, the solution and the presented method may be generalized for patients with similar conditions. The research aimed to solve a generalized problem, taking a typical case from the study area as a reference. Data were collected on the use of the current improving prosthesis-specifically in interaction with its socket-to obtain information on the new approach design: this step constituted the work's starting point, where the problems to be solved in conventional designs were revealed. Currently, the development of this type of support does not consider the functionality and comfort of the patient. Research has reported that 58% of patients with sockets have rejected their use, because they do not fit comfortably and functionally; therefore, patients' low acceptance or rejection of the use of the prosthesis socket has been documented. In this study, different designs were evaluated, based on the FEM as scientific support for the results obtained, for the development of a new ergonomic fit with a 60% increase in patient compliance, that had correct gait performance when correcting postures, improved fit-user interaction, and that presented an esthetic fit that met the usability factor. The validation of the results was carried out through the physical construction of the prototype. The research showed how the finite element method improved the design, analyzing the structural behavioral, and that it could reduce cost and time instead of generating several prototypes.
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Affiliation(s)
- Ana Karen González
- Engineering Faculty, Universidad Autónoma de Querétaro, Querétaro 76010, Mexico
| | - Juvenal Rodríguez-Reséndiz
- Engineering Faculty, Universidad Autónoma de Querétaro, Querétaro 76010, Mexico
- Correspondence: (J.R.-R.); (J.M.O.R.)
| | | | - Juan Manuel Olivares Ramírez
- Department of Renewable Energy, Universidad Tecnológica de San Juan del Río, Querétaro 76800, Mexico
- Correspondence: (J.R.-R.); (J.M.O.R.)
| | - Adyr A. Estévez-Bén
- Engineering Faculty, Universidad Autónoma de Querétaro, Querétaro 76010, Mexico
- Chemistry Faculty, Universidad Autónoma de Querétaro, Querétaro 76010, Mexico
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Li G, Shen N, Deng H, Wang Y, Kong G, Shi J, Dong N, Deng C. Abnormal mechanical stress on bicuspid aortic valve induces valvular calcification and inhibits Notch1/NICD/Runx2 signal. PeerJ 2023; 11:e14950. [PMID: 36908813 PMCID: PMC9997191 DOI: 10.7717/peerj.14950] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2022] [Accepted: 02/03/2023] [Indexed: 03/08/2023] Open
Abstract
Background Bicuspid aortic valve (BAV) is a congenital cardiac deformity, increasing the risk of developing calcific aortic valve disease (CAVD). The disturbance of hemodynamics can induce valvular calcification, but the mechanism has not been fully identified. Methods We constructed a finite element model (FEM) of the aortic valve based on the computed tomography angiography (CTA) data from BAV patients and tricuspid aortic valve (TAV) individuals. We analyzed the hemodynamic properties based on our model and investigated the characteristics of mechanical stimuli on BAV. Further, we detected the expression of Notch, NICD and Runx2 in valve samples and identified the association between mechanical stress and the Notch1 signaling pathway. Results Finite element analysis showed that at diastole phase, the equivalent stress on the root of BAV was significantly higher than that on the TAV leaflet. Correspondingly, the expression of Notch1 and NICH decreased and the expression of Runx2 elevated significantly on large BAV leaflet belly, which is associated with equivalent stress on leaflet. Our findings indicated that the root of BAV suffered higher mechanical stress due to the abnormal hemodynamic environment, and the disturbance of the Notch1/NICD/Runx2 signaling pathway caused by mechanical stimuli contributed to valvular calcification.
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Affiliation(s)
- Guangzhou Li
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Na Shen
- Department of Breast and Thyroid Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Huifang Deng
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Yixuan Wang
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Gangcheng Kong
- Department of Hepatobiliary and Pancreatic Surgery, the First Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou, China
| | - Jiawei Shi
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Nianguo Dong
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Cheng Deng
- Department of Cardiovascular Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
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Nappi F, Avtaar Singh SS, Nappi P, Fiore A. Biomechanics of Transcatheter Aortic Valve Implant. Bioengineering (Basel) 2022; 9:bioengineering9070299. [PMID: 35877350 PMCID: PMC9312295 DOI: 10.3390/bioengineering9070299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2022] [Revised: 06/28/2022] [Accepted: 06/29/2022] [Indexed: 11/16/2022] Open
Abstract
Transcatheter aortic valve implantation (TAVI) has grown exponentially within the cardiology and cardiac surgical spheres. It has now become a routine approach for treating aortic stenosis. Several concerns have been raised about TAVI in comparison to conventional surgical aortic valve replacement (SAVR). The primary concerns regard the longevity of the valves. Several factors have been identified which may predict poor outcomes following TAVI. To this end, the lesser-used finite element analysis (FEA) was used to quantify the properties of calcifications which affect TAVI valves. This method can also be used in conjunction with other integrated software to ascertain the functionality of these valves. Other imaging modalities such as multi-detector row computed tomography (MDCT) are now widely available, which can accurately size aortic valve annuli. This may help reduce the incidence of paravalvular leaks and regurgitation which may necessitate further intervention. Structural valve degeneration (SVD) remains a key factor, with varying results from current studies. The true incidence of SVD in TAVI compared to SAVR remains unclear due to the lack of long-term data. It is now widely accepted that both are part of the armamentarium and are not mutually exclusive. Decision making in terms of appropriate interventions should be undertaken via shared decision making involving heart teams.
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Affiliation(s)
- Francesco Nappi
- Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint-Denis, France
- Correspondence: ; Tel.: +33-149334104; Fax: +33-149334119
| | | | - Pierluigi Nappi
- Department of Clinical and Experimental Medicine, University of Messina, 98122 Messina, Italy;
| | - Antonio Fiore
- Department of Cardiac Surgery, Hôpitaux Universitaires Henri Mondor, Assistance Publique-Hôpitaux de Paris, 94000 Creteil, France;
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Esmailie F, Razavi A, Yeats B, Sivakumar SK, Chen H, Samaee M, Shah IA, Veneziani A, Yadav P, Thourani VH, Dasi LP. Biomechanics of Transcatheter Aortic Valve Replacement Complications and Computational Predictive Modeling. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100032. [PMID: 37273734 PMCID: PMC10236878 DOI: 10.1016/j.shj.2022.100032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/09/2021] [Accepted: 11/03/2021] [Indexed: 06/06/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is a rapidly growing field enabling replacement of diseased aortic valves without the need for open heart surgery. However, due to the nature of the procedure and nonremoval of the diseased tissue, there are rates of complications ranging from tissue rupture and coronary obstruction to paravalvular leak, valve thrombosis, and permanent pacemaker implantation. In recent years, computational modeling has shown a great deal of promise in its capabilities to understand the biomechanical implications of TAVR as well as help preoperatively predict risks inherent to device-patient-specific anatomy biomechanical interaction. This includes intricate replication of stent and leaflet designs and tested and validated simulated deployments with structural and fluid mechanical simulations. This review outlines current biomechanical understanding of device-related complications from TAVR and related predictive strategies using computational modeling. An outlook on future modeling strategies highlighting reduced order modeling which could significantly reduce the high time and cost that are required for computational prediction of TAVR outcomes is presented in this review paper. A summary of current commercial/in-development software is presented in the final section.
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Affiliation(s)
- Fateme Esmailie
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Atefeh Razavi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Breandan Yeats
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sri Krishna Sivakumar
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Huang Chen
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Milad Samaee
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Imran A. Shah
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alessandro Veneziani
- Department of Mathematics, Department of Computer Science, Emory University, Atlanta, Georgia, USA
| | - Pradeep Yadav
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Lakshmi Prasad Dasi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
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Structural Heart Valve Disease in the Era of Change and Innovation: The Crosstalk between Medical Sciences and Engineering. Bioengineering (Basel) 2022; 9:bioengineering9060230. [PMID: 35735473 PMCID: PMC9220173 DOI: 10.3390/bioengineering9060230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Accepted: 05/18/2022] [Indexed: 11/29/2022] Open
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10
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Jianming L, Wentao Y, Wenshuo W, Wang S, Lai W. Comparison of Balloon-Expandable Valve and Self-Expandable Valve in Transcatheter Aortic Valve Replacement: A Patient-Specific Numerical Study. J Biomech Eng 2022; 144:1140206. [PMID: 35420119 DOI: 10.1115/1.4054332] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2021] [Indexed: 11/08/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) is a minimally invasive strategy for the treatment of aortic stenosis. The complex post-operative complications of TAVR were related to the type of implanted prosthetic valve, and the deep mechanism of this relationship may guide the clinical pre-operative planning. The purpose of this study was to develop a numerical method of TAVR to compare the outcome difference between balloon-expandable valve and self-expandable valve and predict the post-operative results. A complete patient-specific aortic model was reconstructed. Two prosthetic valves (balloon-expandable valve and self-expandable valve) were introduced to simulate the implantation procedure, and post-procedural function was studied with fluid-structure interaction method, respectively. Results showed similar stress distribution for two valves, but higher peak stress for balloon-expandable valve model. Compared with the self-expandable valve, the balloon-expandable valve was associated with a better circular cross-section and smaller paravalvular gaps area. Hemodynamic parameters like cardiac output, mean transvalvular pressure difference and effective orifice area (EOA) of the balloon-expandable valve model were better than those of the self-expandable valve model. Significant outcome difference was found for two prosthetic valves. Balloon-expandable valve may effectively decrease the risk and degree of post-operative paravalvular leak, while self-expandable valve was conducive to lower stroke risk due to lower aortic stress. The numerical TAVR simulation process may become an assistant tool for prosthesis selection in pre-operative planning and post-operative prediction.
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Affiliation(s)
- Li Jianming
- Department of Aeronautics and Astronautics, Fudan University, Institute of Biomechanics, Fudan University, Shanghai, 200433, China
| | - Yan Wentao
- Department of Aeronautics and Astronautics, Fudan University, Institute of Biomechanics, Fudan University, Shanghai, 200433, China
| | - Wang Wenshuo
- Department of Cardiac Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China
| | - Shengzhang Wang
- Department of Aeronautics and Astronautics, Fudan University, Academy for Engineering and Technology, Institute of Biomedical Engineering Technology, Fudan University, Institute of Biomechanics, Fudan University, Shanghai, 200433, China
| | - Wei Lai
- Department of Cardiac Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, 200032, China
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11
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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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12
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Exploring the Operative Strategy for Secondary Mitral Regurgitation: A Systematic Review. BIOMED RESEARCH INTERNATIONAL 2021; 2021:3466813. [PMID: 34258260 PMCID: PMC8245239 DOI: 10.1155/2021/3466813] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/25/2021] [Revised: 06/05/2021] [Accepted: 06/16/2021] [Indexed: 01/16/2023]
Abstract
Background Mitral valve disease surgery is an evolving field with multiple possible interventions. There is an increasing body of evidence regarding the optimal strategy in secondary mitral regurgitation where the pathology lies within the ventricle. We conducted a systematic review to identify the benefits and limitations of each surgical option. Methods A systematic review of the literature was performed to identify pertinent randomized controlled trials (RCTs), propensity-matched observational series, and meta-analyses which were considered initially and followed by unmatched observational series using the MEDLINE, Ovid EMBASE, and Cochrane Library. Results We identified 6 different strategies for treating secondary mitral valve regurgitation: mitral valve replacement, restrictive mitral annuloplasty, surgical revascularization (with and without mitral annuloplasty), subvalvular procedures (papillary muscle approximation, papillary muscle relocation, ring and string procedure), and procedures directly targeting the mitral valve (edge-to-edge repair and anterior leaflet enlargement) alongside transcatheter heart valve therapy. We also highlighted the role of left ventricular assist devices in the management of this condition. The benefits and limitations of each intervention are highlighted. Conclusion There is currently no unanimous and shared strategy for the optimal treatment of patients with secondary IMR. The management of patients with secondary mitral regurgitation must be entrusted to a multidisciplinary Heart Team to ensure ideal intervention and patient matching for the best outcomes.
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