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Ning L, Zanella S, Tomov ML, Amoli MS, Jin L, Hwang B, Saadeh M, Chen H, Neelakantan S, Dasi LP, Avazmohammadi R, Mahmoudi M, Bauser-Heaton HD, Serpooshan V. Targeted Rapamycin Delivery via Magnetic Nanoparticles to Address Stenosis in a 3D Bioprinted in Vitro Model of Pulmonary Veins. Adv Sci (Weinh) 2024:e2400476. [PMID: 38696618 DOI: 10.1002/advs.202400476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/12/2024] [Revised: 04/09/2024] [Indexed: 05/04/2024]
Abstract
Vascular cell overgrowth and lumen size reduction in pulmonary vein stenosis (PVS) can result in elevated PV pressure, pulmonary hypertension, cardiac failure, and death. Administration of chemotherapies such as rapamycin have shown promise by inhibiting the vascular cell proliferation; yet clinical success is limited due to complications such as restenosis and off-target effects. The lack of in vitro models to recapitulate the complex pathophysiology of PVS has hindered the identification of disease mechanisms and therapies. This study integrated 3D bioprinting, functional nanoparticles, and perfusion bioreactors to develop a novel in vitro model of PVS. Bioprinted bifurcated PV constructs are seeded with endothelial cells (ECs) and perfused, demonstrating the formation of a uniform and viable endothelium. Computational modeling identified the bifurcation point at high risk of EC overgrowth. Application of an external magnetic field enabled targeting of the rapamycin-loaded superparamagnetic iron oxide nanoparticles at the bifurcation site, leading to a significant reduction in EC proliferation with no adverse side effects. These results establish a 3D bioprinted in vitro model to study PV homeostasis and diseases, offering the potential for increased throughput, tunability, and patient specificity, to test new or more effective therapies for PVS and other vascular diseases.
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Affiliation(s)
- Liqun Ning
- Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, 30322, USA
- Department of Mechanical Engineering, Cleveland State University, Cleveland, OH, 44115, USA
| | - Stefano Zanella
- Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - Martin L Tomov
- Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - Mehdi Salar Amoli
- Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - Linqi Jin
- Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - Boeun Hwang
- Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - Maher Saadeh
- Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - Huang Chen
- Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - Sunder Neelakantan
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA
| | - Lakshmi Prasad Dasi
- Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, 30322, USA
| | - Reza Avazmohammadi
- Department of Biomedical Engineering, Texas A&M University, College Station, TX, 77843, USA
- J. Mike Walker '66 Department of Mechanical Engineering, Texas A&M University, College Station, TX, 77840, USA
| | - Morteza Mahmoudi
- Department of Radiology and Precision Health Program, Michigan State University, East Landing, MI, 48824, USA
| | - Holly D Bauser-Heaton
- Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
- Sibley Heart Center at Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
| | - Vahid Serpooshan
- Wallace H. Coulter Department of Biomedical Engineering, Emory University School of Medicine and Georgia Institute of Technology, Atlanta, GA, 30322, USA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA, 30322, USA
- Children's Healthcare of Atlanta, Atlanta, GA, 30322, USA
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Robinson A, Nkansah A, Bhat S, Karnik S, Jones S, Fairley A, Leung J, Wancura M, Sacks MS, Dasi LP, Cosgriff-Hernandez E. Hydrogel-polyurethane fiber composites with enhanced microarchitectural control for heart valve replacement. J Biomed Mater Res A 2024; 112:586-599. [PMID: 38018452 DOI: 10.1002/jbm.a.37641] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 09/22/2023] [Accepted: 10/24/2023] [Indexed: 11/30/2023]
Abstract
Polymeric heart valves offer the potential to overcome the limited durability of tissue based bioprosthetic valves and the need for anticoagulant therapy of mechanical valve replacement options. However, developing a single-phase material with requisite biological properties and target mechanical properties remains a challenge. In this study, a composite heart valve material was developed where an electrospun mesh provides tunable mechanical properties and a hydrogel coating confers an antifouling surface for thromboresistance. Key biological responses were evaluated in comparison to glutaraldehyde-fixed pericardium. Platelet and bacterial attachment were reduced by 38% and 98%, respectively, as compared to pericardium that demonstrated the antifouling nature of the hydrogel coating. There was also a notable reduction (59%) in the calcification of the composite material as compared to pericardium. A custom 3D-printed hydrogel coating setup was developed to make valve composites for device-level hemodynamic testing. Regurgitation fraction (9.6 ± 1.8%) and effective orifice area (1.52 ± 0.34 cm2 ) met ISO 5840-2:2021 requirements. Additionally, the mean pressure gradient was comparable to current clinical bioprosthetic heart valves demonstrating preliminary efficacy. Although the hemodynamic properties are promising, it is anticipated that the random microarchitecture will result in suboptimal strain fields and peak stresses that may accelerate leaflet fatigue and degeneration. Previous computational work has demonstrated that bioinspired fiber microarchitectures can improve strain homogeneity of valve materials toward improving durability. To this end, we developed advanced electrospinning methodologies to achieve polyurethane fiber microarchitectures that mimic or exceed the physiological ranges of alignment, tortuosity, and curvilinearity present in the native valve. Control of fiber alignment from a random fiber orientation at a normalized orientation index (NOI) 14.2 ± 6.9% to highly aligned fibers at a NOI of 85.1 ± 1.4%. was achieved through increasing mandrel rotational velocity. Fiber tortuosity and curvilinearity in the range of native valve features were introduced through a post-spinning annealing process and fiber collection on a conical mandrel geometry, respectively. Overall, these studies demonstrate the potential of hydrogel-polyurethane fiber composite as a heart valve material. Future studies will utilize the developed advanced electrospinning methodologies in combination with model-directed fabrication toward optimizing durability as a function of fiber microarchitecture.
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Affiliation(s)
- Andrew Robinson
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Abbey Nkansah
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Sanchita Bhat
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Shweta Karnik
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Sarah Jones
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Ashauntee Fairley
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Jonathan Leung
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Megan Wancura
- Department of Chemistry, The University of Texas at Austin, Austin, Texas, USA
| | - Michael S Sacks
- Department of Biomedical Engineering, The University of Texas at Austin, Austin, Texas, USA
- James T. Willerson Center for Cardiovascular Modeling and Simulation, The Oden Institute for Computational Engineering and Sciences, Austin, Texas, USA
- Department of Mechanical Engineering, The University of Texas at Austin, Austin, Texas, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
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Bhat SS, Bui HT, Farnan A, Vietmeyer K, Armstrong AK, Breuer CK, Dasi LP. Development of Novel Sutureless Balloon Expandable Fetal Heart Valve Device Using Absorbable Polycaprolactone Leaflets. Ann Biomed Eng 2024; 52:386-395. [PMID: 37864043 DOI: 10.1007/s10439-023-03386-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Accepted: 10/10/2023] [Indexed: 10/22/2023]
Abstract
Congenital heart disease (CHD) accounts for nearly one-third of all congenital defects, and patients often require repeated heart valve replacements throughout their lives, due to failed surgical repairs and lack of durability of bioprosthetic valve implants. This objective of this study is to develop and in vitro test a fetal transcatheter pulmonary valve replacement (FTPVR) using sutureless techniques to attach leaflets, as an option to correct congenital defects such as pulmonary atresia with intact ventricular septum (PA/IVS), in utero. A balloon expandable design was analyzed using computational simulations to identify areas of failure. Five manufactured valves were assembled using the unique sutureless approach and tested in the fetal right heart simulator (FRHS) to evaluate hemodynamic characteristics. Computational simulations showed that the commissural loads on the leaflet material were significantly reduced by changing the attachment techniques. Hemodynamic analysis showed an effective orifice area of 0.08 cm2, a mean transvalvular pressure gradient of 7.52 mmHg, and a regurgitation fraction of 8.42%, calculated over 100 consecutive cardiac cycles. In conclusion, the FTPVR exhibited good hemodynamic characteristics, and studies with biodegradable stent materials are underway.
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Affiliation(s)
- Sanchita S Bhat
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA
| | - Hieu T Bui
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA
| | - Anna Farnan
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA
| | - Katherine Vietmeyer
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA
| | - Aimee K Armstrong
- The Heart Center, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA
| | - Christopher K Breuer
- Department of General Pediatric Surgery, Nationwide Children's Hospital, 700 Children's Dr., Columbus, OH, 43205, USA.
| | - Lakshmi Prasad Dasi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Office 232, 387 Technology Circle NW, Suite 200, Atlanta, GA, 30313-2412, USA.
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Dasi A, Lee B, Polsani V, Yadav P, Dasi LP, Thourani VH. Predicting pressure gradient using artificial intelligence for transcatheter aortic valve replacement. JTCVS Tech 2024; 23:5-17. [PMID: 38352010 PMCID: PMC10859647 DOI: 10.1016/j.xjtc.2023.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Revised: 10/29/2023] [Accepted: 11/09/2023] [Indexed: 02/16/2024] Open
Abstract
Objective After transcatheter aortic valve replacement, the mean transvalvular pressure gradient indicates the effectiveness of the therapy. The objective is to develop artificial intelligence to predict the post-transcatheter aortic valve replacement aortic valve pressure gradient and aortic valve area from preprocedural echocardiography and computed tomography data. Methods A retrospective study was conducted on patients who underwent transcatheter aortic valve replacement due to aortic valve stenosis. A total of 1091 patients were analyzed for pressure gradient predictions (mean age 76.8 ± 9.2 years, 57.8% male), and 1063 patients were analyzed for aortic valve area predictions (mean age 76.7 ± 9.3 years, 57.2% male). An artificial intelligence learning model was trained (training: n = 663 patients, validation: n = 206 patients) and tested (testing: n = 222 patients) to predict pressure gradient, and a separate artificial intelligence learning model was trained (training: n = 640 patients, validation: n = 218 patients) and tested (testing: n = 205 patients) for predicting aortic valve area. Results The mean absolute error for pressure gradient and aortic valve area predictions was 3.0 mm Hg and 0.45 cm2, respectively. Valve sheath size, body surface area, and age were determined to be the top 3 predictors for pressure gradient, and valve sheath size, left ventricular ejection fraction, and aortic annulus mean diameter were identified to be the top 3 predictors of post-transcatheter aortic valve replacement aortic valve area. A training dataset size of more than 500 patients demonstrated good robustness of the artificial intelligence models for pressure gradient and aortic valve area. Conclusions The artificial intelligence-based algorithm has demonstrated potential in predicting post-transcatheter aortic valve replacement transvalvular pressure gradient predictions for patients with aortic valve stenosis. Further studies are necessary to differentiate pressure gradient between valve types.
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Affiliation(s)
- Anoushka Dasi
- Department of Biomedical Engineering, Ohio State University, Columbus, Ohio
| | - Beom Lee
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| | | | - Pradeep Yadav
- Department of Cardiac Surgery, Piedmont Heart Institute, Atlanta, Ga
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| | - Vinod H. Thourani
- Department of Cardiac Surgery, Piedmont Heart Institute, Atlanta, Ga
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Vogl BJ, Chavez-Ponce A, Wentworth A, Erie E, Yadav P, Thourani VH, Dasi LP, Lindman B, Alkhouli M, Hatoum H. Differential Impact of Blood Pressure Control Targets on Epicardial Coronary Flow After Transcatheter Aortic Valve Replacement. Struct Heart 2024; 8:100230. [PMID: 38283570 PMCID: PMC10818148 DOI: 10.1016/j.shj.2023.100230] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/15/2023] [Revised: 07/31/2023] [Accepted: 09/27/2023] [Indexed: 01/30/2024]
Abstract
Background The cause for the association between increased cardiovascular mortality rates and lower blood pressure (BP) after aortic valve replacement (AVR) is unclear. This study aims to assess how the epicardial coronary flow (ECF) after AVR varies as BP levels are changed in the presence of a right coronary lesion. Methods The hemodynamics of a 3D printed aortic root model with a SAPIEN 3 26 deployed were evaluated in an in vitro left heart simulator under a range of varying systolic blood pressure (SBP) and diastolic blood pressure (DBP). ECF and the flow ratio index were calculated. Flow index value <0.8 was considered a threshold for ischemia. Results As SBP decreased, the average ECF decreased below the physiological coronary minimum at 120 mmHg. As DBP decreased, the average ECF was still maintained above the physiological minimum. The flow ratio index was >0.9 for SBP ≥130 mmHg. However, at an SBP of 120 mmHg, the flow ratio was 0.63 (p ≤ 0.0055). With decreasing DBP, no BP condition yielded a flow ratio index that was less than 0.91. Conclusions Reducing BP to the current recommended levels assigned for the general population after AVR in the presence of coronary artery disease may require reconsideration of levels and treatment priority. Additional studies are needed to fully understand the changes in ECF dynamics after AVR in the presence and absence of coronary artery disease.
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Affiliation(s)
- Brennan J. Vogl
- Biomedical Engineering Department, Michigan Technological University, Houghton, Michigan, USA
| | | | - Adam Wentworth
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Eric Erie
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | - Pradeep Yadav
- Department of Cardiovascular Surgery, 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
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Brian Lindman
- Division of Cardiovascular Medicine, Structural Heart and Valve Center, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Mohamad Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Hoda Hatoum
- Biomedical Engineering Department, Michigan Technological University, Houghton, Michigan, USA
- Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybersystems, Michigan Technological University, Houghton, Michigan, USA
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Sirset TN, Yeats B, Sivakumar SK, Venkatesh A, Sathananthan J, Lilly S, Al-Azizi K, Szerlip M, Polsani V, Yadav P, Thourani V, Dasi LP. CRT-700.11 Peak Areal Stretch Location as a Variable to Predict Aortic Root Rupture Risk Using Pre-Procedural Computational Modeling. JACC Cardiovasc Interv 2023. [DOI: 10.1016/j.jcin.2023.01.274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/22/2023]
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7
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Chen H, Dasi LP. An In-Vitro Study of the Flow Past a Transcatheter Aortic Valve Using Time-Resolved 3D Particle Tracking. Ann Biomed Eng 2023:10.1007/s10439-023-03147-8. [PMID: 36705865 DOI: 10.1007/s10439-023-03147-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2022] [Accepted: 01/11/2023] [Indexed: 01/28/2023]
Abstract
The performance of a transcatheter aortic valve (TAV) can be evaluated by analyzing the flow field downstream of the valve. However, three dimensional flow and pressure fields, and particle residence time, a quantity closely related to thrombosis risk, are challenging to obtain. This experimental study aims to provide a comprehensive 3D measurement of the flow field downstream of an Edwards SAPIEN 3 using time-resolved 3D particle tracking velocimetry (3D PTV) with Shake-the-Box (STB) algorithm. The valve was deployed in an idealized aorta model and tested in a left heart simulator under physiological conditions. Detailed 3D vortical structures, pressure distributions, and particle residence time were obtained by analyzing the 3D particle tracks. Results have shown large-scale retrograde flow entering the sinuses of the TAV at systole, reducing flow stasis there. However, the 3D particle tracks reveal that the retrograde flow has a high residence time and might have already experienced high shear stress near the main jet. Thus by only focusing on the flow in the sinus region is not sufficient to evaluate the leaflet thrombosis risk, and the flow downstream of the valve should be taken into consideration. The unique perspectives offered by 3D PTV are important when evaluating the performance of the TAVs.
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Affiliation(s)
- Huang Chen
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle
- Office 245, Atlanta, GA, 30313-2412, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle
- Office 245, Atlanta, GA, 30313-2412, USA.
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Esmailie F, Hatoum H, Thourani VH, Dasi LP. The impact of local blood residence time in neo-sinus on post transcatheter aortic valve replacement subclinical leaflet thrombosis-a commentary. Interdiscip Cardiovasc Thorac Surg 2023; 36:6992643. [PMID: 36802266 PMCID: PMC9931063 DOI: 10.1093/icvts/ivad012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 01/21/2023]
Affiliation(s)
- Fateme Esmailie
- Corresponding author. Department of Biomedical Engineering, University of North Texas, UNT Discovery Park, 3940 North Elm Street, K240A, Denton, TX 76207, USA. Tel: +1-940-369-8988; e-mail: (F. Esmailie)
| | - Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA,Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Lakshmi Prasad Dasi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, GA, USA
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9
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Baig I, Lee AJ, Brinkman W, Gopal A, Dasi LP, Al-Azizi K. Simultaneous Kissing Balloon Inflation of the Transcatheter Aortic Valve Replacement Valve and an Ostial Coronary Stent-A Novel Coronary Protection Technique. Struct Heart 2022; 6:100074. [PMID: 37288126 PMCID: PMC10242579 DOI: 10.1016/j.shj.2022.100074] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 02/24/2022] [Revised: 05/21/2022] [Accepted: 06/27/2022] [Indexed: 06/09/2023]
Affiliation(s)
- Imran Baig
- Baylor Scott & White Health The Heart Hospital - Plano, Plano, Texas, USA
| | - Arthur J. Lee
- Baylor Scott & White Health The Heart Hospital - Plano, Plano, Texas, USA
| | - William Brinkman
- Baylor Scott & White Health The Heart Hospital - Plano, Plano, Texas, USA
| | - Ambarish Gopal
- Baylor Scott & White Health The Heart Hospital - Plano, Plano, Texas, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | - Karim Al-Azizi
- Baylor Scott & White Health The Heart Hospital - Plano, Plano, Texas, USA
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10
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Bui HT, Ishrat A, James SP, Dasi LP. Design consideration of a novel polymeric transcatheter heart valve through computational modeling. J Mech Behav Biomed Mater 2022; 135:105434. [PMID: 36116342 DOI: 10.1016/j.jmbbm.2022.105434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/23/2022] [Accepted: 08/28/2022] [Indexed: 11/29/2022]
Abstract
Transcatheter heart valve replacement is becoming a more routine procedure, and this is further supported by positive outcomes from studies involving low-risk patients. Nevertheless, the lack of long-term transcatheter heart valve (TAV) durability is still one of the primary concerns. As a result, more research has been focused on improving durability through various methods such as valve design, computational modeling, and material selection. Recent advancements in polymeric valve fabrication showed that linear low-density polyethylene (LLDPE) could be used as leaflet material for transcatheter heart valves. In this paper, a parametric study of computational simulations showed stress distribution on the leaflets of LLDPE-TAV under diastolic load, and the results were used to improve the stent design. The in silico experiment also tested the effect of shock absorbers in terms of valve durability. The results demonstrated that altering specific stent angles can significantly lower peak stress on the leaflets (13.8 vs. 6.07 MPa). Implementing two layers of shock absorbers further reduces the stress value to 4.28 MPa. The pinwheeling index was assessed, which seems to correlate with peak stress. Overall, the parametric study and the computational method can be used to analyze and improve valve durability.
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Affiliation(s)
- Hieu T Bui
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Cir NW, Atlanta, GA, 30313, USA
| | - Amina Ishrat
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Cir NW, Atlanta, GA, 30313, USA
| | - Susan P James
- School of Advanced Materials Discovery, Colorado State University, 700 Meridian Ave, Fort Collins, CO, 80523, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Cir NW, Atlanta, GA, 30313, USA.
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11
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Tomov ML, Perez L, Ning L, Chen H, Jing B, Mingee A, Ibrahim S, Theus AS, Kabboul G, Do K, Bhamidipati SR, Fischbach J, McCoy K, Zambrano BA, Zhang J, Avazmohammadi R, Mantalaris A, Lindsey BD, Frakes D, Dasi LP, Serpooshan V, Bauser-Heaton H. A 3D Bioprinted In Vitro Model of Pulmonary Artery Atresia to Evaluate Endothelial Cell Response to Microenvironment. Adv Healthc Mater 2022; 11:e2201227. [PMID: 35794082 DOI: 10.1002/adhm.202201227] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Indexed: 11/05/2022]
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12
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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. Struct Heart 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] [What about the content of this article? (0)] [Affiliation(s)] [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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13
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Wang Z, Dasi LP, Hatoum H. Controlling the Flow Separation in Heart Valves Using Vortex Generators. Ann Biomed Eng 2022; 50:914-928. [PMID: 35415767 DOI: 10.1007/s10439-022-02966-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2021] [Accepted: 04/06/2022] [Indexed: 11/25/2022]
Abstract
A comprehensive computational study is performed to investigate the effectiveness of vortex generators (VGs) applied to mechanical bi-leaflet heart valves. Co-rotating and counter-rotating VG configurations are compared to a control valve without VGs. Detailed flow fields are obtained and used to elucidate the underlying flow physics. It was found that VGs reduce flow separation over the leaflets and hence reduce the Reynolds shear stress (RSS) in the vicinity regions of heart valve. The co-rotating VG configuration demonstrates a better performance compared with the counter-rotating configuration in terms of the RSS, turbulent kinetic energy production and velocity distributions, especially in the peripheral jet flows. The fraction of blood damage in the co-rotating configuration shows a 4.7% reduction in comparison to the control case, while a 3.7% increase is observed in the counter-rotating configuration. The passive flow control technique of applying co-rotating VG illustrates a great potential to help mitigate the hemodynamic factors leading to potential blood damage risk.
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Affiliation(s)
- Zhenyu Wang
- Simulation Innovation and Modeling Center (SIMCenter), The Ohio State University, Columbus, OH, USA.,Department of Mechanical and Aerospace Engineering, The Ohio State University, Columbus, OH, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA. .,Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA.
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14
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Samaee M, Hatoum H, Biersmith M, Yeats B, Gooden SC, Thourani VH, Hahn RT, Lilly S, Yoganathan A, Dasi LP. Gradient and pressure recovery of a self-expandable transcatheter aortic valve depends on ascending aorta size: In vitro study. JTCVS Open 2022; 9:28-38. [PMID: 36003461 PMCID: PMC9390729 DOI: 10.1016/j.xjon.2022.01.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 01/12/2022] [Indexed: 11/25/2022]
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15
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Hatoum H, Ahn S, Lilly S, Maureira P, Crestanello J, Thourani VH, Dasi LP. Flow dynamics of surgical and transcatheter aortic valves: Past to present. JTCVS Open 2022; 9:43-56. [PMID: 36003460 PMCID: PMC9390780 DOI: 10.1016/j.xjon.2022.01.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/10/2020] [Accepted: 01/12/2022] [Indexed: 11/15/2022]
Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Mich
- Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Mich
- Center of Biocomputing and Digital Health, Michigan Technological University, Houghton, Mich
- Address for reprints: Hoda Hatoum, PhD, Department of Biomedical Engineering, Michigan Technological University, 1400 Townsend Dr, Houghton, MI 49931.
| | - Sunyoung Ahn
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Mich
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Pablo Maureira
- Department of Cardiovascular Surgery, CHU de Nancy, Nancy, France
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minn
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
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16
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Sivakumar SK, Yadav P, Polsani VR, Thourani VH, Dasi LP. COMPUTATIONAL MODELING OF CORONARY OBSTRUCTION IN VALVE-IN-VALVE TAVR: CHOOSING THE RIGHT VIRTUAL VALVE TO CORONARY DISTANCE. J Am Coll Cardiol 2022. [DOI: 10.1016/s0735-1097(22)01769-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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17
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Hatoum H, Gooden SCM, Sathananthan J, Sellers S, Kutting M, Marx P, Lilly SM, Ihdayhid AR, Thourani VH, Dasi LP. Neosinus and Sinus Flow After Self-Expanding and Balloon-Expandable Transcatheter Aortic Valve Replacement. JACC Cardiovasc Interv 2021; 14:2657-2666. [PMID: 34838462 DOI: 10.1016/j.jcin.2021.09.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 09/10/2021] [Accepted: 09/14/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate flow dynamics in the aortic sinus and the neosinus (NS) after transcatheter heart valve (THV) implantation in valve-in-valve (ViV). BACKGROUND Leaflet thrombosis may occur on THVs and affect performance and durability. Differences in flow dynamics may affect the risk for leaflet thrombosis. METHODS Hemodynamic assessment following THV implantation in a surgical aortic valve was performed in a left heart simulator under pulsatile physiological conditions. Assessment was performed using a 23-mm polymeric surgical aortic valve (not diseased) and multiple THV platforms, including self-expanding devices (26-mm Evolut, 23-mm Allegra, small ACURATE neo) and a balloon-expandable device (23-mm SAPIEN 3). Particle image velocimetry was performed to assess flow in the sinus and NS. Sinus and NS washout, shear stress, and velocity were calculated. RESULTS Sinus and NS washout was fastest and approximately 1 cardiac cycle for each with the Evolut, ACURATE neo, and Allegra compared with the SAPIEN 3, with washout in 2 and 3 cardiac cycles, respectively. The Allegra showed the largest shear stress distribution in the sinus, followed by the SAPIEN 3. In the NS, all 4 valves showed equal likelihoods of occurrence of shear stress <1 Pa, but the Allegra showed the highest likelihoods of occurrence for shear stress >1 Pa. The velocities in the sinus and NS were 0.05, 0.078, 0.080, and 0.075 m/s for Evolut, SAPIEN 3, ACURATE neo, and Allegra ViV, respectively. CONCLUSIONS Sinus and NS flow dynamics differ substantially among THVs after ViV. Self-expanding supra-annular valves seem to have faster washouts compared with an equivalent-size balloon-expandable THV.
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Affiliation(s)
- Hoda Hatoum
- Biomedical Engineering Department, Michigan Technological University, Houghton, Michigan, USA; Health Research Institute, Houghton, Michigan, USA; Center for Biocomputing and Digital Health, Michigan Technological University, Houghton, Michigan, USA.
| | - Shelley C M Gooden
- Biomedical Engineering Department, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Janarthanan Sathananthan
- Center for Cardiovascular Innovation, Cardiovascular Translational Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | - Stephanie Sellers
- Center for Cardiovascular Innovation, Cardiovascular Translational Laboratory, St. Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
| | | | | | - Scott M Lilly
- Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio, USA
| | - Abdul R Ihdayhid
- Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, Perth, Australia
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Lakshmi Prasad Dasi
- Biomedical Engineering Department, Georgia Institute of Technology, Atlanta, Georgia, USA
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18
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Hatoum H, Singh-Gryzbon S, Esmailie F, Ruile P, Neumann FJ, Blanke P, Thourani VH, Yoganathan AP, Dasi LP. Predictive Model for Thrombus Formation After Transcatheter Valve Replacement. Cardiovasc Eng Technol 2021; 12:576-588. [PMID: 34859378 PMCID: PMC11034843 DOI: 10.1007/s13239-021-00596-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 11/09/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Leaflet thrombosis is a significant adverse event after transcatheter aortic valve (TAV) replacement (TAVR). The purpose of our study was to present a semi-empirical, mathematical model that links patient-specific anatomic, valve, and flow parameters to predict likelihood of leaflet thrombosis. METHODS The two main energy sources of neo-sinus (NS) washout after TAVR include the jet flow downstream of the TAV and NS geometric change in volume due to the leaflets opening and closing. Both are highly dependent on patient anatomic and hemodynamic factors. As rotation of blood flow is prevalent in both the sinus of Valsalva and then the NS, we adopted the vorticity flux or circulation (Г) as a metric quantifying overall washout. Leaflet thrombus volumes were segmented based on hypo-attenuating leaflet thickening (HALT) in post-TAVR patient's gated computed tomography. Г was assessed using dimensional scaling as well as computational fluid dynamics (CFD) respectively and correlated to the thrombosis volumes using sensitivity and specificity analysis. RESULTS Г in the NS, that accounted for patient flow and anatomic conditions derived from scaling arguments significantly better predicted the occurrence of leaflet thrombus than CFD derived measures such as stasis volumes or wall shear stress. Given results from the six patient datasets considered herein, a threshold Г value of 28.0 yielded a sensitivity and specificity of 100% where patients with Gamma < 28 developed valve thrombosis. A 10% error in measurements of all variables can bring the sensitivity specificity down to 87%. CONCLUSION A predictive model relating likelihood of valve thrombosis using Г in the NS was developed with promising sensitivity and specificity. With further studies and improvements, this predictive technology may lead to alerting physicians on the risk for thrombus formation following TAVR.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | - Shelly Singh-Gryzbon
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
- Department of Chemical & Process Engineering, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Fateme Esmailie
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Blanke
- University of British Columbia and St. Paul's Hospital in Vancouver, Vancouver, Canada
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Ajit P Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA.
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19
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Heitkemper M, Sivakumar S, Hatoum H, Dollery J, Lilly SM, Dasi LP. Simple 2-dimensional anatomic model to predict the risk of coronary obstruction during transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2021; 162:1075-1083.e1. [PMID: 32222410 PMCID: PMC7434688 DOI: 10.1016/j.jtcvs.2020.01.085] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/11/2019] [Revised: 01/17/2020] [Accepted: 01/21/2020] [Indexed: 12/30/2022]
Abstract
OBJECTIVE In this study, a 2-dimensional (2D) index relying on preprocedural computed tomography (CT) data was developed to evaluate the risk of coronary obstruction during transcatheter aortic valve replacement (TAVR) procedures. METHODS Anatomic measurements from pre-TAVR CT scans were collected in 28 patients among 600 who were flagged as high risk (defined as meeting coronary artery height, h, <14 mm and/or sinus of Valsalva diameter, SOVd, <30 mm) for coronary obstruction. A geometric model derived from these anatomic measurements was used to predict the post-TAVR native cusp apposition relative to the coronary ostium. The distance from the cusp to the coronary ostium, DLC2D, was measured from the geometric model and indexed with the coronary artery diameter, d, to yield a fractional obstruction measure, DLC2D/d. RESULTS Twenty-three of 28 high-risk patients successfully underwent TAVR without coronary obstruction, of whom 1 had coronary obstruction and 4 were deemed non-TAVR candidates. DLC2D/d differed significantly between the 2 groups (P < .0018), but neither h nor SOVd did (P > .32). The optimal sensitivity and specificity for DLC2D/d were 85% and occurred at a cutoff of 0.45. The optimal sensitivity and specificity of h and SOVd in this high-risk group were only 60% and 40%, respectively, for cutoffs of h = 10 mm and SOVd = 30.5 mm. CONCLUSIONS The 2D geometric model derived in this study shows promise for identifying patients with low-lying coronary ostium and/or small SOVd that may be safely treated with TAVR. DLC2D/d is more predictive of obstruction or poor TAVR candidacy compared with h and SOVd.
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Affiliation(s)
- Megan Heitkemper
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Srikrishna Sivakumar
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| | - Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| | - Jennifer Dollery
- Division of Cardiology, The Ohio State University, Columbus, Ohio
| | - Scott M Lilly
- Division of Cardiology, The Ohio State University, Columbus, Ohio
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga.
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20
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Tomov ML, Perez L, Ning L, Chen H, Jing B, Mingee A, Ibrahim S, Theus AS, Kabboul G, Do K, Bhamidipati SR, Fischbach J, McCoy K, Zambrano BA, Zhang J, Avazmohammadi R, Mantalaris A, Lindsey BD, Frakes D, Dasi LP, Serpooshan V, Bauser‐Heaton H. A 3D Bioprinted In Vitro Model of Pulmonary Artery Atresia to Evaluate Endothelial Cell Response to Microenvironment. Adv Healthc Mater 2021; 10:e2100968. [PMID: 34369107 DOI: 10.1002/adhm.202100968] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/24/2021] [Indexed: 12/20/2022]
Abstract
Vascular atresia are often treated via transcatheter recanalization or surgical vascular anastomosis due to congenital malformations or coronary occlusions. The cellular response to vascular anastomosis or recanalization is, however, largely unknown and current techniques rely on restoration rather than optimization of flow into the atretic arteries. An improved understanding of cellular response post anastomosis may result in reduced restenosis. Here, an in vitro platform is used to model anastomosis in pulmonary arteries (PAs) and for procedural planning to reduce vascular restenosis. Bifurcated PAs are bioprinted within 3D hydrogel constructs to simulate a reestablished intervascular connection. The PA models are seeded with human endothelial cells and perfused at physiological flow rate to form endothelium. Particle image velocimetry and computational fluid dynamics modeling show close agreement in quantifying flow velocity and wall shear stress within the bioprinted arteries. These data are used to identify regions with greatest levels of shear stress alterations, prone to stenosis. Vascular geometry and flow hemodynamics significantly affect endothelial cell viability, proliferation, alignment, microcapillary formation, and metabolic bioprofiles. These integrated in vitro-in silico methods establish a unique platform to study complex cardiovascular diseases and can lead to direct clinical improvements in surgical planning for diseases of disturbed flow.
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Affiliation(s)
- Martin L. Tomov
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
| | - Lilanni Perez
- Department of Pediatrics Emory University School of Medicine Atlanta GA 30322 USA
| | - Liqun Ning
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
| | - Huang Chen
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
| | - Bowen Jing
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
| | - Andrew Mingee
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
| | - Sahar Ibrahim
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
| | - Andrea S. Theus
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
| | - Gabriella Kabboul
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
| | - Katherine Do
- Department of Pediatrics Emory University School of Medicine Atlanta GA 30322 USA
| | - Sai Raviteja Bhamidipati
- J. Mike Walker ’66 Department of Mechanical Engineering Texas A&M University College Station TX 77843 USA
| | - Jordan Fischbach
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
| | - Kevin McCoy
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
| | - Byron A. Zambrano
- J. Mike Walker ’66 Department of Mechanical Engineering Texas A&M University College Station TX 77843 USA
| | - Jianyi Zhang
- Department of Biomedical Engineering School of Medicine and School of Engineering University of Alabama at Birmingham Birmingham AL G094J USA
| | - Reza Avazmohammadi
- J. Mike Walker ’66 Department of Mechanical Engineering Texas A&M University College Station TX 77843 USA
- Department of Biomedical Engineering Texas A&M University College Station TX 77843 USA
| | - Athanasios Mantalaris
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
| | - Brooks D. Lindsey
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
- School of Electrical and Computer Engineering Atlanta GA 30322 USA
| | - David Frakes
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
- School of Electrical and Computer Engineering Atlanta GA 30322 USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
| | - Vahid Serpooshan
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
- Department of Pediatrics Emory University School of Medicine Atlanta GA 30322 USA
- Children's Healthcare of Atlanta Atlanta GA 30322 USA
| | - Holly Bauser‐Heaton
- Department of Biomedical Engineering Emory University School of Medicine and Georgia Institute of Technology Atlanta GA 30322 USA
- Department of Pediatrics Emory University School of Medicine Atlanta GA 30322 USA
- Children's Healthcare of Atlanta Atlanta GA 30322 USA
- Sibley Heart Center at Children's Healthcare of Atlanta Atlanta GA 30322 USA
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21
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Bui HT, Khair N, Yeats B, Gooden S, James SP, Dasi LP. Transcatheter Heart Valves: A Biomaterials Perspective. Adv Healthc Mater 2021; 10:e2100115. [PMID: 34038627 DOI: 10.1002/adhm.202100115] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/23/2021] [Indexed: 11/11/2022]
Abstract
Heart valve disease is prevalent throughout the world, and the number of heart valve replacements is expected to increase rapidly in the coming years. Transcatheter heart valve replacement (THVR) provides a safe and minimally invasive means for heart valve replacement in high-risk patients. The latest clinical data demonstrates that THVR is a practical solution for low-risk patients. Despite these promising results, there is no long-term (>20 years) durability data on transcatheter heart valves (THVs), raising concerns about material degeneration and long-term performance. This review presents a detailed account of the materials development for THVRs. It provides a brief overview of THVR, the native valve properties, the criteria for an ideal THV, and how these devices are tested. A comprehensive review of materials and their applications in THVR, including how these materials are fabricated, prepared, and assembled into THVs is presented, followed by a discussion of current and future THVR biomaterial trends. The field of THVR is proliferating, and this review serves as a guide for understanding the development of THVs from a materials science and engineering perspective.
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Affiliation(s)
- Hieu T. Bui
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Nipa Khair
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Breandan Yeats
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Shelley Gooden
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Susan P. James
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
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22
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Hatoum H, Gooden S, Sathananthan J, Lilly S, Ihdayhid AR, Thourani V, Dasi LP. SINUS AND NEO-SINUS FLOW EVALUATION AFTER IMPLANTATION OF AN EVOLUT, SAPIEN 3, ACCURATE NEO AND ALLEGRA TRANSCATHETER VALVES. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03064-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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23
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Farsiani Y, Parthasarathy J, Molossi S, Mery C, Razavi A, Dasi LP, Krishnamurthy R. BIOMECHANICAL FLOW MODELING USING PATIENT-SPECIFIC 3D PRINTED MODEDLS FOR SURGICAL DECISION-MAKING IN ANOMALOUS AORTIC ORIGIN OF CORONARY ARTERY. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)01808-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Samaee M, Hatoum H, Thourani V, Yoganathan A, Dasi LP. EFFECT OF ASCENDING AORTA SIZE IN TRANSCATHETER AORTIC VALVE PERFORMANCE: COMPARISON BETWEEN EVOLUT R AND SAPIEN 3. J Am Coll Cardiol 2021. [DOI: 10.1016/s0735-1097(21)03124-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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25
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Parthasarathy J, Hatoum H, Flemister DC, Krull CM, Walter BA, Zhang W, Mery CM, Molossi S, Jadhav S, Dasi LP, Krishnamurthy R. Assessment of transfer of morphological characteristics of Anomalous Aortic Origin of a Coronary Artery from imaging to patient specific 3D Printed models: A feasibility study. Comput Methods Programs Biomed 2021; 201:105947. [PMID: 33535084 DOI: 10.1016/j.cmpb.2021.105947] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/18/2020] [Accepted: 01/17/2021] [Indexed: 06/12/2023]
Abstract
BACKGROUND AND OBJECTIVE This study aims to determine the accuracy of patient specific 3D printed models in capturing pathological anatomical characteristics derived from CT angiography (CTA) in children with anomalous aortic origin of a coronary artery (AAOCA). METHODS & MATERIALS Following institutional regulatory approval, a standardized protocol for CTA of AAOCA was utilized for imaging. Blood volume of the aorta and coronaries were segmented from the DICOM images. A total of 10 models from 8 AAOCA patients were created, including 2 post-operative models. Mechanical properties of Agilus30 a flexible photopolymer coated with a thin layer of parylene, polyurethane (PU) and silicone and native aortic tissue from a postmortem specimen were compared. AAOCA models with wall thicknesses of 2mm aorta and 1.5mm coronaries were 3D printed in Agilus30 and coated with PU. CT of the printed models was performed, and 3D virtual models were generated. Transfer of anatomical characteristics and geometric accuracy were compared between the patient model virtual models. RESULTS Dynamic modulus of Agilus30 at 2mm thickness was found to be close to native aortic tissue. Structured reporting of anatomical characteristics by imaging experts showed good concordance between patient and model CTA Comparative patient and virtual model measurements showed Pearson's correlation (r) of 0.9959 for aorta (n=70) and 0.9538 for coronaries (n=60) linear, and 0.9949 for aorta (n=30) and 0.9538 for coronaries (n=30) cross-sectional, dimensions. Surface contour map mean difference was 0.08 ± 0.29mm. CONCLUSIONS Geometrically accurate AAOCA models preserving morphological characteristics, essential for risk stratification and decision-making, can be 3D printed from a patient's CTA.
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Affiliation(s)
- Jayanthi Parthasarathy
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Dr, E4A Columbus, Columbus, OH 43205, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Dorma C Flemister
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Carly M Krull
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Benjamin A Walter
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Wei Zhang
- Department of Biostatistics & Data Science, University of Texas HSC, School of Public Health, Houston USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School / Dell Children's Medical Center, Austin, TX, USA
| | - Silvana Molossi
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School / Dell Children's Medical Center, Austin, TX, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Siddharth Jadhav
- Department of Radiology, Texas Children's Hospital, Baylor College of Medicine Houston, TX, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA
| | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, 700 Children's Dr, E4A Columbus, Columbus, OH 43205, USA; Department of Pediatrics, Section of Pediatric Cardiology, Texas Children's Hospital, Baylor College of Medicine, Houston, TX, USA.
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Bailoor S, Seo JH, Dasi LP, Schena S, Mittal R. A computational study of the hemodynamics of bioprosthetic aortic valves with reduced leaflet motion. J Biomech 2021; 120:110350. [PMID: 33743394 DOI: 10.1016/j.jbiomech.2021.110350] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2021] [Accepted: 02/22/2021] [Indexed: 01/25/2023]
Abstract
We employ a reduced degree-of-freedom aortic valve model to investigate the flow physics associated with early-stage reduced leaflet motion in bioprosthetic aortic valves. The model is coupled with a sharp-interface immersed boundary based incompressible flow solver to efficiently simulate the fluid-structure interaction. A total of 19 cases of flow through aortic valves with varying degrees of reduced leaflet motion (RLM) are considered. The characteristics of the aortic jet and the consequent aorta wall loading patterns are analyzed. Our results show that asymmetric RLM tilts the aortic jet and leads to large reverse and recirculating flow regions downstream from leaflets with restricted mobility. The changes in flow patterns increase wall pressure and shear stress fluctuations, and result in asymmetric oscillating shear on the aorta wall. These findings have implications for auscultation based diagnosis of this condition as well as the health of the aorta.
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Hatoum H, Askegaard G, Iyer R, Prasad Dasi L. Atrial and ventricular flows across a transcatheter mitral valve. Interact Cardiovasc Thorac Surg 2021; 33:1-9. [PMID: 33674829 DOI: 10.1093/icvts/ivab032] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2020] [Revised: 11/20/2020] [Accepted: 01/10/2021] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES The objective of this study was to evaluate the haemodynamic performance of transcatheter mitral valve replacement (TMVR) Implant with a focus on turbulence and washout adjacent to the ventricular surface of the leaflets. TMVR holds the promise of treating a large spectrum of mitral valve diseases. However, the haemodynamic performance and flow dynamics of such replacements are not fully understood. METHODS A tri-leaflet biopsrosthetic TMVR represented by Caisson implant of size 36A was implanted in the mitral position of a left heart simulator pulse duplicating system under physiological conditions. The 36A implant covers an anterior-posterior range of 26-32 mm and a commissure-to-commissure range of 30-36 mm. Transmitral pressure gradient, effective orifice area and regurgitant fraction were calculated. Particle image velocimetry was performed to evaluate turbulence in 2 perpendicular planes (Reynolds and viscous shear stresses, respectively). Additionally, dye experiments were performed to visualize washout. RESULTS Transmitral pressure gradient was 1.29 ± 0.27 mmHg and effective orifice area was 2.96 ± 0.28 cm2. Regurgitant fraction was 14.13 ± 0.08%. Total washout was 4.27 cardiac cycles. Largest viscous shear stress reaches 3.7 Pa and 2.4 Pa in ventricle and atrium, respectively. Reynolds shear stress in the atrial side was <10 Pa. In the ventricular side, the largest Reynolds shear stress reached ∼35 Pa. CONCLUSIONS TMVR leads to favourable haemodynamics with low degree of turbulence combined with fast washout around the leaflets indicating promising potential for freedom from blood damage potential and thrombosis corroborated by initial clinical studies as part of the valves's Early Feasibility Study.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | | | - Ramji Iyer
- R&D Department, LivaNova PLC, Maple Grove, MN, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
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Hatoum H, Thourani VH, Dasi LP. Predicting Leaflet Thrombosis: Is the Clue in the Blood? Ann Thorac Surg 2021; 112:1727-1728. [PMID: 33581149 DOI: 10.1016/j.athoracsur.2021.01.048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Accepted: 01/20/2021] [Indexed: 10/22/2022]
Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle NW, Atlanta, GA 30313.
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29
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Hatoum H, Krishnamurthy R, Parthasarathy J, Flemister DC, Krull CM, Walter BA, Mery CM, Molossi S, Dasi LP. Flow Dynamics in Anomalous Aortic Origin of a Coronary Artery in Children: Importance of the Intramural Segment. Semin Thorac Cardiovasc Surg 2020; 34:226-235. [PMID: 33242612 PMCID: PMC11062399 DOI: 10.1053/j.semtcvs.2020.11.027] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2020] [Accepted: 11/17/2020] [Indexed: 01/02/2023]
Abstract
This study aims to assess the differences in pressure, fractional flow reserve (FFR) and coronary flow (with increasing pressure) of the proximal coronary artery in patients with anomalous aortic origin of a coronary artery with a confirmed ischemic event, without ischemic events, and before and after unroofing surgery, and compare to a patient with normal coronary arteries. Patient-specific flow models were 3D printed for 3 subjects with anomalous right coronary arteries with intramural course, 2 of them had documented ischemia, and compared with a patient with normal coronaries. The models were placed in the aortic position of a pulse duplicator and precise measurements to quantify FFR and coronary flow rate were performed from the aortic to the mediastinal segment of the anomalous right coronary artery. In an ischemic model, a gradual FFR drop (emulating that of pressure) was shown from the ostium location (∼1.0) to the distal intramural course (0.48). In nonischemic and normal patient models, FFR for all locations did not drop below 0.9. In a second ischemic model prior to repair, a drop to 0.44 was encountered at the intramural and mediastinal intersection, improving to 0.86 postrepair. There is a difference in instantaneous coronary flow rate with increasing aortic pressure in the ischemic models (slope 0.2846), compared to the postrepair and normal models (slope >0.53). These observations on patient models support a biomechanical basis for ischemia and potentially sudden cardiac death in aortic origin of a coronary artery, with a drop in pressure and FFR in the intramural segment, and a decrease in coronary flow rate with increasing aortic pressure, with both improving after corrective surgery.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio..
| | - Jayanthi Parthasarathy
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Dorma C Flemister
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Carly M Krull
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Benjamin A Walter
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Carlos M Mery
- Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School / Dell Children's Medical Center, Austin, Texas
| | - Silvana Molossi
- Section of Pediatric Cardiology, Department of Pediatrics, Texas Children's Hospital, Baylor College of Medicine, Houston, Texas
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia..
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30
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Hatoum H, Dasi LP, Krishnamurthy R, Molossi S, Mery CM. Commentary: Computational Fluid Dynamics in Anomalous Coronaries: Moving From Anecdote-Based to Data-Based Clinical Decision-Making. Semin Thorac Cardiovasc Surg 2020; 33:168-169. [PMID: 33171233 DOI: 10.1053/j.semtcvs.2020.09.034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2020] [Accepted: 09/25/2020] [Indexed: 11/11/2022]
Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Rajesh Krishnamurthy
- Department of Radiology, Nationwide Children's Hospital, The Ohio State University College of Medicine, Columbus, Ohio
| | - Silvana Molossi
- Department of Pediatrics, Texas Children's Hospital/Baylor College of Medicine, Houston, Texas
| | - Carlos M Mery
- Department of Surgery and Perioperative Care, Texas Center for Pediatric and Congenital Heart Disease, University of Texas Dell Medical School/Dell Children's Medical Center, Austin, Texas.
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Hatoum H, Vallabhuneni S, Kota AK, Bark DL, Popat KC, Dasi LP. Impact of superhydrophobicity on the fluid dynamics of a bileaflet mechanical heart valve. J Mech Behav Biomed Mater 2020; 110:103895. [PMID: 32957201 PMCID: PMC11046437 DOI: 10.1016/j.jmbbm.2020.103895] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2019] [Revised: 05/13/2020] [Accepted: 05/30/2020] [Indexed: 11/27/2022]
Abstract
OBJECTIVE The objective of this study is to evaluate the impact of superhydrophobic coating on the hemodynamics and turbulence characteristics of a bileaflet mechanical valve in the context of evaluating blood damage potential. METHODS Two 3D printed bileaflet mechanical valves were hemodynamically tested in a pulse duplicator under physiological pressure and flow conditions. The leaflets of one of the two valves were sprayed with a superhydrophobic coating. Particle Image Velocimetry was performed. Pressure gradients (PG), effective orifice areas (EOA), Reynolds shear stresses (RSS) and instantaneous viscous shear stresses (VSS) were calculated. RESULTS (a) Without SH coating, the PG was found to be 14.53 ± 0.7 mmHg and EOA 1.44 ± 0.06 cm2. With coating, the PG obtained was 15.21 ± 1.7 mmHg and EOA 1.39 ± 0.07 cm2; (b) during peak systole, the magnitude of RSS with SH coating (110Pa) exceeded that obtained without SH coating (40 Pa) with higher probabilities to develop higher RSS in the immediate wake of the leaflet; (c) The magnitudes range of instantaneous VSS obtained with SH coating were slightly larger than those obtained without SH coating (7.0 Pa versus 5.0 Pa). CONCLUSION With Reynolds Shear Stresses and instantaneous Viscous Shear Stresses being correlated with platelet damage, SH coating did not lead to their decrease. While SH coating is known to improve surface properties such as reduced platelet or clot adhesion, the relaxation of the slip condition does not necessarily improve overall hemodynamic performance for the bileaflet mechanical valve design.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA
| | - Sravanthi Vallabhuneni
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
| | - Arun Kumar Kota
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC, USA
| | - David L Bark
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Ketul C Popat
- Department of Mechanical Engineering, Colorado State University, Fort Collins, CO, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
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Hatoum H, Lilly S, Maureira P, Crestanello J, Prasad Dasi L. Sinus Hemodynamics After Transcatheter Aortic Valve in Transcatheter Aortic Valve. Ann Thorac Surg 2020; 110:1348-1356. [PMID: 32179042 PMCID: PMC11069388 DOI: 10.1016/j.athoracsur.2020.02.016] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2019] [Revised: 12/07/2019] [Accepted: 02/04/2020] [Indexed: 12/24/2022]
Abstract
BACKGROUND This study evaluated the effect of transcatheter aortic valve (TAV)-in-TAV on sinus hemodynamics and washout. With TAV becoming the standard procedure for aortic valve replacement and with the limited valve durability, a second intervention is necessary (TAV-in-TAV) after first TAV failure. METHODS Six arrangements of TAV-in-TAV were chosen for this study as follows: (1) Evolut 23 (Medtronic, Minneapolis, MN) in Evolut 26, (2) Evolut 23 in SAPIEN 3 23 (Edwards Lifesciences, Irvine, CA), (3) Evolut 26 in Evolut 26, (4) Evolut 26 in SAPIEN 23, (5) SAPIEN 3 23 in Evolut 26, and (6) SAPIEN 3 23 in SAPIEN 3 23. These TAV-in-TAV configurations were assessed in a pulse duplicator. Particle image velocimetry was performed. RESULTS During systole, (1) the highest velocity was found with SAPIEN-in-SAPIEN (0.7 m/s) and the lowest was with Evolut 26-in-Evolut 26 (0.2 m/s); (2) the highest shear stress magnitude near the leaflet was with Evolut 23-in-SAPIEN (1.45 Pa) and the lowest was with Evolut 26-in-Evolut 26 (0.55 Pa); and (3) washout was almost equal in all sinuses of these cases (<2.5 cycles). CONCLUSIONS This study shows that TAV-in-TAV is highly dependent on the valve that is originally implanted and the valve to be implanted. Washout is not significantly degraded after TAV-in-TAV compared with valve-in-valve and TAV replacement. Further studies are needed to optimize valve size and selection.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Pablo Maureira
- Department of Cardiovascular Surgery, Centre Hospitalier Universitaire de Nancy, Nancy, France
| | - Juan Crestanello
- Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia.
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Sathananthan J, Hensey M, Fraser R, Landes U, Blanke P, Hatoum H, Dasi LP, Sedaghat A, Bapat VN, Leipsic J, Søndergaard L, Wood DA, Webb JG. Implications of hydrodynamic testing to guide sizing of self-expanding transcatheter heart valves for valve-in-valve procedures. Catheter Cardiovasc Interv 2020; 96:E332-E340. [PMID: 31647178 DOI: 10.1002/ccd.28537] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2019] [Accepted: 09/27/2019] [Indexed: 11/07/2022]
Abstract
AIMS The commonly used valve-in-valve (VIV) app recommends sizing based on dimensions of both the transcatheter heart valve (THV) and bioprosthetic surgical valve. The implications of hydrodynamic testing to guide VIV sizing are poorly understood. This bench study assessed the hydrodynamic performance of different sizes of self-expanding supra-annular THVs in three different surgical aortic bioprostheses at different implantation depths. METHODS A small versus medium ACURATE neo (ACn), and a 26 mm versus 29 mm Evolut R were assessed after VIV implantation in 25 mm Mitroflow, Mosaic, and Magna Ease aortic surgical bioprostheses, at three implantation depths (+2 mm, -2 mm, and -6 mm). RESULTS The medium-sized ACn had lower gradients compared to the small ACn when the THV was implanted high (+2 mm, or -2 mm). The 29 mm Evolut R had lower gradients compared to a 26 mm Evolut R for all implantation depths, except for a depth of -2 mm in the 25 mm Mitroflow. The medium ACn and 29 mm Evolut R had larger effective orifice areas compared to the small ACn and 26 mm Evolut R, respectively. Both Evolut R sizes had acceptable regurgitant fractions (<15%), while both ACn sizes were above the acceptable performance criteria (>15%), at all implantation depths. CONCLUSIONS Use of a larger self-expanding THV was associated with superior hydrodynamic performance if the THV was implanted high. Hydrodynamic testing can provide additional information to the VIV app to help guide VIV sizing.
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Affiliation(s)
- Janarthanan Sathananthan
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Mark Hensey
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | | | - Uri Landes
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - Philipp Blanke
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Alexander Sedaghat
- Med. Klinik und Poliklinik II, Herzzentrum, Universitätsklinikum Bonn, Germany
| | | | - Jonathon Leipsic
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
- Department of Radiology, St. Paul's Hospital and University of British Columbia, Vancouver, Canada
| | - Lars Søndergaard
- Department of Cardiology, Rigshospitalet, Copenhagen University Hospital, Copenhagen, Denmark
| | - David A Wood
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
| | - John G Webb
- Centre for Heart Valve Innovation, St Paul's Hospital, University of British Columbia, Vancouver, Canada
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Hatoum H, Maureira P, Lilly S, Dasi LP. Impact of Leaflet Laceration on Transcatheter Aortic Valve-in-Valve Washout: BASILICA to Solve Neosinus and Sinus Stasis. JACC Cardiovasc Interv 2020; 12:1229-1237. [PMID: 31272669 DOI: 10.1016/j.jcin.2019.04.013] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2018] [Revised: 03/26/2019] [Accepted: 04/09/2019] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The aim of this study was to evaluate any potential leaflet washout benefits after bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (BASILICA) in transcatheter valve-in-valve (ViV) in the context of leaflet thrombosis. BACKGROUND Leaflet thrombosis after transcatheter aortic valve replacement is secondary to flow stasis in both the sinus and neosinus. Strategies to improve washout and ameliorate neosinus and sinus flow velocities may have the potential to mitigate the occurrence of clinical and subclinical leaflet thrombosis. METHODS A 23-mm Edwards SAPIEN 3 and a 26-mm Medtronic Evolut were deployed in a 23-mm transparent surgical aortic valve model before and after leaflet laceration. The valves were placed in the aortic position of a pulse duplicator flow loop. Particle image velocimetry was performed to quantify sinus flow hemodynamic status. A tracing fluorescent dye was injected to evaluate the number of cycles to washout in both regions of interest. RESULTS The leaflet laceration procedure led to an increase in the velocities in the sinus and the neosinus by 50% for Evolut ViV and 61.9% for SAPIEN 3 ViV. In addition, leaflet laceration led to a reduction in overall cycles to washout in the neosinus by at least 56% with the Evolut and 54.5% with the SAPIEN 3 and in the sinus by at least 16.7% with the Evolut and 60.8% with the SAPIEN. CONCLUSIONS Leaflet laceration using a BASILICA-type approach may hold the potential to mitigate neosinus and sinus flow stasis. Controlled in vivo trials are necessary to establish the potential benefit of BASILICA to reduce the occurrence of leaflet thrombosis.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Pablo Maureira
- Department of Cardiovascular Surgery, CHU de Nancy, Nancy, France
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio.
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35
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Zakko J, Blum KM, Drews JD, Wu YL, Hatoum H, Russell M, Gooden S, Heitkemper M, Conroy O, Kelly J, Carey S, Sacks M, Texter K, Ragsdale E, Strainic J, Bocks M, Wang Y, Dasi LP, Armstrong AK, Breuer C. Development of Tissue Engineered Heart Valves for Percutaneous Transcatheter Delivery in a Fetal Ovine Model. JACC Basic Transl Sci 2020; 5:815-828. [PMID: 32875171 PMCID: PMC7452327 DOI: 10.1016/j.jacbts.2020.06.009] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Revised: 06/10/2020] [Accepted: 06/10/2020] [Indexed: 02/06/2023]
Abstract
A fully biodegradable fetal valve was developed using a zinc-aluminum alloy stent and electrospun PCL leaflets. In vitro evaluation of the valve was performed with accelerated degradation, mechanical, and flow loop testing, and the valve showed trivial stenosis and trivial regurgitation. A large animal model was used for percutaneous delivery of the valve to the fetal pulmonary annulus. Following implantation, the valve had no stenosis or regurgitation by echocardiography, and the fetal sheep matured and was delivered at term with the tissue-engineered valve.
This multidisciplinary work shows the feasibility of replacing the fetal pulmonary valve with a percutaneous, transcatheter, fully biodegradable tissue-engineered heart valve (TEHV), which was studied in vitro through accelerated degradation, mechanical, and hemodynamic testing and in vivo by implantation into a fetal lamb. The TEHV exhibited only trivial stenosis and regurgitation in vitro and no stenosis in vivo by echocardiogram. Following implantation, the fetus matured and was delivered at term. Replacing a stenotic fetal valve with a functional TEHV has the potential to interrupt the development of single-ventricle heart disease by restoring proper flow through the heart.
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Key Words
- EOA, effective orifice area
- MPA, main pulmonary artery
- Mn, molecular size
- Mw, molecular weight
- NOI, normalized orientation index
- PCL, polycaprolactone
- PDI, polydispersity index
- PG, pressure gradient
- RF, regurgitant fraction
- RV, right ventricular/ventricle
- SEM, scanning electron microscopy
- TEHV, tissue-engineered heart valve
- congenital heart disease
- tissue-engineered heart valve
- transcatheter heart valve
- translational medicine
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Affiliation(s)
- Jason Zakko
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Kevin M Blum
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Biomedical Engineering, Ohio State University, Columbus, Ohio
| | - Joseph D Drews
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Yen-Lin Wu
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Hoda Hatoum
- Coulter Department of Biomedical Engineering, Georgia Tech, Atlanta, Georgia
| | - Madeleine Russell
- Oden Institute for Computational and Engineering Sciences, University of Texas at Austin, Austin, Texas
| | - Shelley Gooden
- Coulter Department of Biomedical Engineering, Georgia Tech, Atlanta, Georgia
| | - Megan Heitkemper
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Biomedical Engineering, Ohio State University, Columbus, Ohio
| | - Olivia Conroy
- Oden Institute for Computational and Engineering Sciences, University of Texas at Austin, Austin, Texas
| | - John Kelly
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Stacey Carey
- Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Michael Sacks
- Oden Institute for Computational and Engineering Sciences, University of Texas at Austin, Austin, Texas
| | - Karen Texter
- Heart Center, Nationwide Children's Hospital, Columbus, Ohio
| | - Ellie Ragsdale
- Department of OB/GYN-Maternal Fetal Medicine, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - James Strainic
- Department of Pediatric Cardiology, University Hospitals Rainbow Babies and Children's Hospital, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Martin Bocks
- University Hospitals Rainbow Babies and Children's Hospital, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Yadong Wang
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, New York
| | - Lakshmi Prasad Dasi
- Coulter Department of Biomedical Engineering, Georgia Tech, Atlanta, Georgia
| | | | - Christopher Breuer
- Center for Regenerative Medicine, Abigail Wexner Research Institute at Nationwide Children's Hospital, Columbus, Ohio.,Department of Surgery, Ohio State University Wexner Medical Center, Columbus, Ohio
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Hatoum H, Gooden S, Heitkemper M, Blum KM, Zakko J, Bocks M, Yi T, Wu YL, Wang Y, Breuer CK, Dasi LP. Fetal Transcatheter Trileaflet Heart Valve Hemodynamics: Implications of Scaling on Valve Mechanics and Turbulence. Ann Biomed Eng 2020; 48:1683-1693. [PMID: 32052320 PMCID: PMC7286783 DOI: 10.1007/s10439-020-02475-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2019] [Accepted: 02/05/2020] [Indexed: 01/09/2023]
Abstract
The scarcity of data available on the best approach for pulmonary fetal valve replacement or implantation necessitate an investigation on whether practices using adult transcatheter valves could be translated to fetal applications. The objective of this study is to evaluate the hemodynamic characteristics and the turbulent properties of a fetal sized trileaflet transcatheter pulmonary valve in comparison with an adult balloon-expandable valve in order to assess the possibility of designing valves for fetal applications using dynamic similarity. A 6 mm fetal trileaflet valve and a 26 mm SAPIEN 3 valve were assessed in a pulse duplicator. Particle image velocimetry was performed. Pressure gradient (ΔP), effective orifice area (EOA), regurgitant fractions (RF), pinwheeling indices (PI) and turbulent stresses were evaluated. ΔP was 8.56 ± 0.139 and 7.76 ± 0.083 mmHg with fetal valve and SAPIEN respectively (p < 0.0001); EOA was 0.10 ± 0.0007 and 2.1 ± 0.025 cm2 with fetal valve and SAPIEN respectively (p < 0.0001); RF with the fetal valve was 2.35 ± 1.99% and with SAPIEN 10.92 ± 0.11% (p < 0.0001); PI with fetal valve was 0.404 ± 0.01 and with SAPIEN 0.37 ± 0.07; The flow regime with the fetal valve was turbulent and Reynolds numbers reached about 7000 while those with the SAPIEN reached about 20,000 at peak velocity. Turbulent stresses were significantly higher with fetal valve compared with SAPIEN. Instantaneous viscous shear stresses with fetal valve were 5.8 times higher than those obtained with SAPIEN and Reynolds shear stresses were 2.5 times higher during peak systole. The fetal valve implantation leads to a turbulent flow (specific to this particular type and design of valve) regime unlike what is expected of a small valve with different flow properties compared to adult valves.
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Affiliation(s)
- Hoda Hatoum
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle NW, Atlanta, GA, 30313, USA
| | - Shelley Gooden
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle NW, Atlanta, GA, 30313, USA
| | - Megan Heitkemper
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Kevin M Blum
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Jason Zakko
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Martin Bocks
- Case Western Reserve University School of Medicine, UH Rainbow Babies & Children's Hospital, Cleveland, OH, USA
| | - Tai Yi
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Yen-Lin Wu
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Yadong Wang
- Meinig School of Biomedical Engineering, Cornell University, Ithaca, NY, USA
| | - Christopher K Breuer
- Center for Regenerative Medicine, Tissue Engineering Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH, USA
| | - Lakshmi Prasad Dasi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle NW, Atlanta, GA, 30313, USA.
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Gooden SCM, Hatoum H, Zhang W, Boudoulas KD, Dasi LP. Multiple MitraClips: The balancing act between pressure gradient and regurgitation. J Thorac Cardiovasc Surg 2020; 163:1319-1327.e1. [PMID: 32711989 DOI: 10.1016/j.jtcvs.2020.05.049] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2019] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 12/31/2022]
Abstract
OBJECTIVE Transcatheter mitral valve repair with the MitraClip is used for the symptomatic management of mitral regurgitation (MR). The challenge is reducing MR while avoiding an elevated mitral valve gradient (MVG). This study assesses how multiple MitraClips used to treat MR can affect valve performance. METHODS Six porcine mitral valves were assessed using an in vitro left heart simulator in the native, moderate-to-severe MR, and severe MR cases. MR cases were tested in the no-MitraClip, 1-MitraClip, and 2-MitraClip configurations. Mitral regurgitant fraction (MRF), MVG, and effective orifice area (EOA) were quantified. RESULTS Native MRF, MVG, and EOA were 14.22%, 2.59 mm Hg, and 1.64 cm2, respectively. For moderate-to-severe MR, MRF, MVG, and EOA were 34.07%, 3.31 mm Hg, and 2.22 cm2, respectively. Compared with the no-MitraClip case, 1 MitraClip decreased MRF to 18.57% (P < .0001) and EOA to 1.50 cm2 (P = .0002). MVG remained statistically unchanged (3.44 mm Hg). Two MitraClips decreased MRF to 14.26% (P < .0001) and EOA to 1.36 cm2 (P = .0001). MVG remained unchanged (3.29 mm Hg). For severe MR, MRF, MVG, and EOA were 59.79%, 4.98 mm Hg, and 2.73 cm2, respectively. Compared with the no-MitraClip case, 1 MitraClip decreased MRF to 30.72% (P < .0001) and EOA to 1.82 cm2 (P < .0001); MVG remained unchanged (4.03 mm Hg). MVG remained statistically unchanged. Two MitraClips decreased MRF to 23.10% (P < .0001) and EOA to 1.58 cm2 (P < .0001); MVG remained statistically unchanged (3.82 mm Hg). Both MR models yielded no statistical difference between 1 and 2 MitraClips. CONCLUSIONS There is limited concern regarding elevation of MVG when reducing MR using 1 or 2 MitraClips, although 2 MitraClips did not significantly continue to reduce MRF.
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Affiliation(s)
| | - Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga
| | - Wei Zhang
- Department of Biostatistics and Data Science, UTHealth, School of Public Health, Houston, Tex
| | | | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Ga.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus (H.H., L.P.D.)
| | - Pablo Maureira
- Department of Cardiovascular Surgery, CHU de Nancy, France (P.M.)
| | - Scott Lilly
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (S.L.)
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus (H.H., L.P.D.)
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Sathananthan J, Fraser R, Hatoum H, Barlow AM, Stanová V, Allen KB, Chhatriwalla AK, Rieu R, Pibarot P, Dasi LP, Søndergaard L, Wood DA, Webb JG. A bench test study of bioprosthetic valve fracture performed before versus after transcatheter valve-in-valve intervention. EUROINTERVENTION 2020; 15:1409-1416. [DOI: 10.4244/eij-d-19-00939] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
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Hatoum H, Hahn RT, Lilly S, Dasi LP. Differences in Pressure Recovery Between Balloon Expandable and Self-expandable Transcatheter Aortic Valves. Ann Biomed Eng 2020; 48:860-867. [PMID: 31792706 PMCID: PMC11043825 DOI: 10.1007/s10439-019-02425-8] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2019] [Accepted: 11/24/2019] [Indexed: 10/25/2022]
Abstract
Pressure recovery downstream of the aortic valve constitutes an important factor affecting the calculation of pressure gradient (PG) across the valve and therefore the accuracy of the calculated aortic valve area. Some clinical studies hypothesized that stent and valve cusps design contribute to flow acceleration and Doppler-measured valve gradients across the balloon-expandable transcatheter aortic valve. This study aims at elucidating the physical mechanisms behind pressure recovery variations between Edwards SAPIEN 3 and Medtronic Evolut TAVs through the measurements of sensitive and precise axial pressure profiles. A 23 mm Edwards SAPIEN3 and a 26 mm Medtronic Evolut were deployed in a pulse duplicator. A Millar catheter was used to record 50 cycles of pressure data along the centerline of the valve chamber upstream and downstream of the valve. The peak PG obtained with SAPIEN at vena contracta (VC) is 18.83 ± 0.75 mmHg and after recovery, 9.56 ± 0.78 mmHg. For Evolut at VC, peak PG is 18.25 ± 0.63 mmHg and after recovery, 10.3 ± 0.57 mmHg. The differences in peak PG at VC and at the recovery were statistically significant (p < 0.001). With SAPIEN 3 at VC, the mean PG obtained is 10.11 ± 0.63 mmHg and after recovery 7.06 ± 0.46 mmHg. For Evolut, mean PG at VC is 10.45 ± 0.67 mmHg and after recovery 7.99 ± 0.61 mmHg. The differences between the mean PG between the two valves was not statistically significant at VC (p = 0.71) but significant post-recovery (p < 0.00001). While gradients at the VC are higher with the SAPIEN 3, the net gradient after pressure recovery is significantly lower compared to Evolut TAV. Efficiency of pressure recovery significantly depends on valve type due to stent interference with the recovering blood flow.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, 473 W 12th Ave, Columbus, OH, 43210, USA
| | - Rebecca T Hahn
- Division of Cardiology, Columbia University Medical Center, New York, NY, USA
| | - Scott Lilly
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, 473 W 12th Ave, Columbus, OH, 43210, USA.
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Quiroz‐Arita C, Blaylock ML, Gharagozloo PE, Bark D, Prasad Dasi L, Bradley TH. Pilot‐scale open‐channel raceways and flat‐panel photobioreactors maintain well‐mixed conditions under a wide range of mixing energy inputs. Biotechnol Bioeng 2020; 117:959-969. [DOI: 10.1002/bit.27268] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2019] [Revised: 11/29/2019] [Accepted: 12/13/2019] [Indexed: 12/22/2022]
Affiliation(s)
- Carlos Quiroz‐Arita
- Sandia National Laboratories Livermore California
- Mechanical Engineering, Colorado State University Fort Collins Colorado
| | | | | | - David Bark
- Mechanical Engineering, Colorado State University Fort Collins Colorado
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering The Ohio State University Columbus Ohio
| | - Thomas H. Bradley
- Systems Engineering, Colorado State University Fort Collins Colorado
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Hatoum H, Dasi LP, Thourani VH. Commentary: Complying With the Compliance of Ross Procedure Reinforcing Grafts. Semin Thorac Cardiovasc Surg 2020; 32:823-824. [DOI: 10.1053/j.semtcvs.2020.06.022] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2020] [Accepted: 06/13/2020] [Indexed: 12/14/2022]
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Hatoum H, Maureira P, Lilly S, Dasi LP. Impact of BASILICA on Sinus and Neo-Sinus Hemodynamics after Valve-in-Valve with and without Coronary Flow. Cardiovasc Revasc Med 2019; 21:271-276. [PMID: 31281093 DOI: 10.1016/j.carrev.2019.06.015] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 11/25/2022]
Abstract
BACKGROUND/PURPOSE This study aims at evaluating the impact of BASILICA on neo-sinus and sinus hemodynamics with and without coronary flow. Leaflet thrombosis after valve-in-valve (ViV) may compromise not only leaflet mobility but also affect valve durability and performance. METHODS/MATERIALS In a 23 mm transparent surgical aortic valve model, a 23 mm Edwards SAPIEN 3 and a 26 mm Medtronic Evolut were deployed before and after leaflet laceration, in models with and without coronary flow. Neo-sinus and sinus hemodynamics were evaluated in the aortic position of a pulse duplicator and particle image velocimetry was performed in order to quantify sinus flow hemodynamics along with sinus and neo-sinus washout. RESULTS BASILICA-type leaflet laceration procedure led to (a) an increase in the velocities in the sinus and the neo-sinus by 50% for Evolut ViV with and without coronary flow, 70% for non-coronary SAPIEN 3 ViV and 10% for coronary SAPIEN 3 ViV, and (b) an improvement in overall washout up to 2 cycles in the neo-sinus and 0.5 cycles in the sinus. CONCLUSIONS A BASILICA-type leaflet laceration approach may improve sinus and neo-sinus hemodynamics through decreasing flow stasis and enabling less confined blood flow. BASILICA confers coronary sinus flow patterns to the non-coronary sinus.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Pablo Maureira
- Department of Cardiovascular Surgery, CHU de Nancy, Nancy, France
| | - Scott Lilly
- Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus, OH, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.
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Heitkemper M, Hatoum H, Dasi LP. In vitro hemodynamic assessment of a novel polymeric transcatheter aortic valve. J Mech Behav Biomed Mater 2019; 98:163-171. [PMID: 31238208 DOI: 10.1016/j.jmbbm.2019.06.016] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2019] [Revised: 06/06/2019] [Accepted: 06/17/2019] [Indexed: 01/12/2023]
Abstract
Transcatheter aortic valve replacement (TAVR) is a life-saving alternative to surgical intervention. However, the identification of features associated with poor outcomes, including residual paravalvular leakage (PVL), leaflet calcification, and subclinical leaflet thrombosis, are cause to be concerned about valve durablilty (Mylotte and Piazza, 2015a, 2015b; Dasi et al., 2017; Makkar et al., 2015; Kheradvar et al., 2015a). The aim of this study is to optimize the potential of a hyaluronan (HA) enhanced polymeric transcatheter aortic valve (HA-TAV) that has promised to reduce blood damage causing-turbulent flow while maintaining durability. HA-enhanced linear low-density polyethylene (LLDPE) leaflets were sutured to novel cobalt chromium stents, size 26 mm balloon expandable stents. Hemodynamic performance was assessed in a left heart simulator under physiological pressure and flow conditions and compared to a 26 mm Medtronic Evolut and 26 mm Edwards SAPIEN 3. High-speed imaging and particle image velocimetry (PIV) were performed. The HA-TAV demonstrated an effective orifice area (EOA) within one standard deviation of the leading valve, SAPIEN 3.The regurgitant fraction (RF) of the HA-TAV (11.23 ± 0.55%) is decreased in comparison the Evolut (15.74 ± 0.73%) and slightly higher than the SAPIEN 3 (10.92 ± 0.11%), which is considered trace regurgitation according to valve standards. A decreased number of higher principal Reynolds shear stresses were shown for the HA-TAV at each cardiac phase. The HA-TAV is directly comparable and in some cases superior to the leading commercially available prosthetic heart valves in in-vitro hemodynamic testing.
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Affiliation(s)
- Megan Heitkemper
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA; Department of Mechanical Engineering, The Ohio State University, Columbus, OH, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA.
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Hatoum H, Lilly SM, Crestanello J, Dasi LP. A case study on implantation strategies to mitigate coronary obstruction in a patient receiving transcatheter aortic valve replacement. J Biomech 2019; 89:115-118. [PMID: 31000346 PMCID: PMC11067729 DOI: 10.1016/j.jbiomech.2019.04.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2018] [Revised: 03/30/2019] [Accepted: 04/06/2019] [Indexed: 11/15/2022]
Abstract
Coronary obstruction is a life threatening complication during and post-transcatheter aortic valve replacement (TAVR). The objective of this preliminary work is to investigate the mechanisms underlying coronary obstruction in a patient after TAVR, in whom coronary obstruction was confirmed in addition to highlighting the importance of pre-procedural planning. The aortic root of an 80-year old male patient with coronary obstruction during TAVR-where a 29 mm SAPIEN 3 was deployed-was segmented from Computed Tomography scans and 3D-printed with compliant material. Flow and pressure data were acquired in this 3D-printed model in-vitro using a pulse duplicator under physiological conditions for the cases: a 29 mm SAPIEN 3, a 26 mm SAPIEN 3 expanded with a 29 mm balloon, and a 31 mm Medtronic-CoreValve deployed annularly, supra and sub-annularly respectively. Only the CoreValve in sub-annular axial position and the 29 mm SAPIEN 3 yielded pressure gradients (PG) lower than 10 mmHg (6.76 ± 0.52 and 5.72 ± 0.13 mmHg respectively) while the 26 mm SAPIEN 3, CoreValve in normal and supra-annular positions yielded higher PGs (15.5 ± 0.48, 12.2 ± 0.15 and 10.8 ± 0.24 mmHg respectively). 29 mm SAPIEN 3 implantation yielded an FFR value of 45.7 ± 0.6%. However, 31 mm CoreValve in any of the three different annular positions yielded FFR values going from 89.6 ± 1.1% in supra-annular position to 98.3 ± 1.1% in sub-annular position. Implantation with a 26 mm SAPIEN 3 expanded with a 29 mm balloon also yielded an FFR of 92.1 ± 1.2%. Coronary obstruction in this patient could have been prevented through usage of different valve types and/or through usage of a different combination of valve size-balloon sizes.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA
| | - Scott M Lilly
- Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA
| | - Juan Crestanello
- Division of Cardiovascular Surgery, Mayo Clinics, Rochester, Minnesota, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, OH, USA; Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA.
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Heitkemper M, Hatoum H, Azimian A, Yeats B, Dollery J, Whitson B, Rushing G, Crestanello J, Lilly SM, Dasi LP. Modeling risk of coronary obstruction during transcatheter aortic valve replacement. J Thorac Cardiovasc Surg 2019; 159:829-838.e3. [PMID: 31230808 DOI: 10.1016/j.jtcvs.2019.04.091] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 04/06/2019] [Accepted: 04/16/2019] [Indexed: 01/06/2023]
Abstract
OBJECTIVE In this study we aimed to evaluate risk of coronary obstruction during transcatheter aortic valve replacement and develop improved criteria based on computational modeling. METHODS Patient specific 3-dimensional models were constructed and validated for 28 patients out of 600 patients who were flagged as high risk for coronary obstruction (defined as meeting coronary ostium height < 14 mm and/or sinus of Valsalva diameter [SOVd] < 30 mm). The models consisted finite element analysis to predict the post- transcatheter aortic valve replacement native cusp apposition relative to the coronary ostium and were validated in vitro. The distance from cusp to coronary ostium (DLC) was derived from the 3-dimensional models and indexed with the coronary artery diameter to yield a fractional obstruction measure (DLC/d). RESULTS Twenty-two out of 28 high-risk patients successfully underwent transcatheter aortic valve replacement without coronary obstruction and 6 did not. DLC/d between the 2 groups was significantly different (P < .00078), whereas neither coronary ostium height nor SOVd were significantly different (P > .32). A cutoff of DLC/d < 0.7 was predictive with 100% sensitivity and 95.7% specificity. The optimal sensitivity and specificity of coronary ostium height and SOVd in this high-risk group was only 60% and 40%, respectively, for cutoff coronary ostium height of 10 mm and SOVd of 30.5 mm. CONCLUSIONS Three-dimensional modeling has the potential to enable more patients to be safely treated with transcatheter aortic valve replacement who have a low-lying coronary ostium or small SOVd. DLC/d is more predictive of obstruction than coronary ostium height and SOVd.
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Affiliation(s)
- Megan Heitkemper
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Amirsepehr Azimian
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Breandan Yeats
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | | | - Bryan Whitson
- Department of Surgery The Ohio State University, Columbus, Ohio
| | - Greg Rushing
- Department of Surgery The Ohio State University, Columbus, Ohio
| | - Juan Crestanello
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio; Department of Surgery The Ohio State University, Columbus, Ohio
| | - Scott M Lilly
- Division of Cardiology, The Ohio State University, Columbus, Ohio
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio; Department of Surgery The Ohio State University, Columbus, Ohio.
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Hatoum H, Mo XM, Crestanello JA, Dasi LP. Modeling of the Instantaneous Transvalvular Pressure Gradient in Aortic Stenosis. Ann Biomed Eng 2019; 47:1748-1763. [PMID: 31037445 DOI: 10.1007/s10439-019-02275-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Accepted: 04/22/2019] [Indexed: 11/30/2022]
Abstract
The simplified and modified Bernoulli equations break down in estimating the true pressure gradient across the stenotic aortic valve due to their over simplifying assumptions of steady and inviscid conditions as well as the fundamental nature in which aortic valves are different than idealized orifices. Nevertheless, despite having newer models based on time-dependent momentum balance across an orifice, the simplified and modified Bernoulli continue to be the clinical standard because to date, they remain the only models clinically implementable. The objective of this study is to (1) illustrate the fundamental considerations necessary to accurately model the time-dependent instantaneous pressure gradient across a fixed orifice and (2) propose empirical corrections when applying orifice based models to severely stenotic aortic valves. We introduce a general model to predict the time-dependent instantaneous pressure gradient across an orifice that explicitly model the Reynolds number dependence of both the steady and unsteady terms. The accuracy of this general model is assessed with respect to previous models through pulse duplicator experiments on a round orifice model as well as an explanted stenotic surgical aortic valve both with geometric areas of 0.6 cm2 (less than 1 cm2 which is the threshold for stenosis determination) over cardiac outputs of 3 and 5 L/min and heart rates of 60, 90 and 120 bpm. The model and the raw experimental data corresponding to the orifice showed good agreement over a wide range of cardiac outputs and heart rates (R2 exceeding 0.91). The derived average and peak transvalvular pressure gradients also demonstrated good agreement with no significant differences between the respective peaks (p > 0.09). The new model proposed holds promise with its physical and closed form representation of pressure drop, however accurate modeling of the time-variability of the valve area is necessary for the model to be applied on stenotic valves.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, 473 W 12th Ave, Columbus, OH, 43210, USA
| | - Xiaokui-Molly Mo
- Department of Biomedical Informatics, College of Medicine, The Ohio State University, Columbus, OH, USA
| | | | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, 473 W 12th Ave, Columbus, OH, 43210, USA.
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Hatoum H, Maureira P, Dasi LP. A turbulence in vitro assessment of On-X and St Jude Medical prostheses. J Thorac Cardiovasc Surg 2019; 159:88-97. [PMID: 30905419 PMCID: PMC6703975 DOI: 10.1016/j.jtcvs.2019.02.046] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 01/17/2019] [Accepted: 02/09/2019] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The objective of this study was to investigate and compare the hemodynamic and turbulence characteristics upon implantation of St Jude Medical (SJM) (St Jude Medical, St Paul, Minn) and On-X (On-X Life Technologies, Kennesaw, Ga) bileaflet mechanical valves. Both valves are considered highly successful bileaflet mechanical valves characterized by good clinical outcomes despite their numerous design differences. Although thromboembolism remains the main disadvantage of bileaflet mechanical valves, On-X valves have been shown to need less anticoagulation therapy. METHODS Hemodynamic assessment of a 23-mm On-X bileaflet mechanical valve and a 23-mm bileaflet SJM valve implanted in an aortic root was performed under pulsatile physiologic conditions. Time-resolved and phase-locked particle-image-velocimetry images and high-speed imaging data were acquired. Pressure gradients, effective orifice areas, dimensionless area index, leaflet position tracking, velocity, and principal Reynolds shear stress were calculated. RESULTS Pressure gradient for the On-X valve was 4.15 ± 0.099 mm Hg versus 4.75 ± 0.048 mm Hg for SJM (P < .001). Effective orifice area for the On-X valve was 2.61 ± 0.045 cm2 versus 2.36 ± 0.022 cm2 for SJM (P < .001). Area index was higher with SJM (0.87 ± 0.008) than with On-X (0.73 ± 0.013) (P < .001). On-X showed fluctuating leaflet behavior during systole, whereas SJM leaflets were stable. At peak systole, the maximal velocity with On-X was 1.86 m/s versus 2.33 m/s with SJM. Reynolds shear stress was higher with On-X compared with SJM at peak systole (95 vs 72 Pa). Higher velocity fluctuation was noted with the On-X valve. CONCLUSIONS This study shows that despite the design differences that characterize the On-X valve, the hemodynamic and turbulence parameters were not necessarily improved compared with SJM.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio
| | - Pablo Maureira
- Department of Cardiovascular Surgery, CHU de Nancy, Nancy, France
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, Columbus, Ohio.
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Hatoum H, Maureira P, Lilly S, Dasi LP. 600.01 Impact of Basilica on Sinus and Neo-Sinus Washout After Transcatheter Aortic Valve-in-Valve. JACC Cardiovasc Interv 2019. [DOI: 10.1016/j.jcin.2019.01.153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Hatoum H, Dasi LP. Spatiotemporal Complexity of the Aortic Sinus Vortex as a Function of Leaflet Calcification. Ann Biomed Eng 2019; 47:1116-1128. [PMID: 30710186 DOI: 10.1007/s10439-019-02224-1] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2018] [Accepted: 01/28/2019] [Indexed: 01/25/2023]
Abstract
Several studies have shown the variation of aortic sinus structures' hemodynamics with different flow and geometric characteristics. They have also correlated aortic sinus hemodynamics with the progression and evolution of calcific aortic valve disease (CAVD). This study aims at visualizing aortic sinus fluid structure variations as functions of different leaflet calcification degrees and assessing their potential relationship with CAVD. A degenerated 23 mm Carpentier-Edwards Perimount Magna valve extracted from a redo-surgery patient was implanted in an aortic root model and tested in a pulse duplicator left heart simulator. The valve has 3 leaflets with 3 different levels of calcium distribution: mild, moderate and severe. High-speed imaging and particle image velocimetry were performed to assess sinus vortices, leaflet tip position and velocity along with shear stress. Results have shown that (a) aortic sinus vortices initiation, entrapment and evolution varied with different calcified leaflet exposure; (b) higher velocities in the sinus were calculated with the mildly calcified leaflet compared to the moderately and severely calcified ones; (c) during systole, the mildly calcified leaflet sinus case shows the most spread-out and higher ranges of shear stress probabilities and highest magnitudes going from (- 1.5 to + 1.8 Pa) compared with (- 1.0 to + 1.0 Pa) for moderately and severely calcified leaflets. The higher the calcification degree the lower the shear stress range and likelihoods of having higher shear stress. This holds in diastole as well. This study shows the impact of calcification on the aortic sinus flow structures.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, The Ohio State University, 473 W 12th Ave, Columbus, OH, 43210, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, The Ohio State University, 473 W 12th Ave, Columbus, OH, 43210, USA. .,Division of Cardiac Surgery, The Ohio State University, Columbus, OH, USA.
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