Myocardial protection strategy for conventional aortic valve replacement following previous coronary surgery: should it be patient-specific?

In the past decade, Transcatheter Aortic Valve Replacement (TAVI) has been shown to be a feasible, less invasive option to open heart surgery for aortic valve replacement; however, TAVI is indicated only in patients with severe, symptomatic, aortic stenosis and who are considered at high or prohibitive risk for conventional surgery [1]. To date, two different TAVI devices are available on the market — the balloon-expandable Edwards-Sapien® Valve (Edwards Lifesciences, CA, USA) and the self-expandable CoreValve ReValving System® (Medtronic, MN, USA) — with many other devices currently under development and clinical trials. The procedural success rate has been >90% in all studies [1], but vascular complications, electrical conduction abnormalities and paravalvular leak — 65–89% of cases, the majority being trivial to mild, with 0 to 26% moderate and 0 to 10% severe — still remain major safety concerns. In particular, a negative influence of moderate to severe paravalvular leak on survival rates has recently been demonstrated [2].

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Modeling of transcatheter aortic valve replacement: Patient specific vs general approaches based on finite element analysis

Computers in Biology and Medicine ◽

10.1016/j.compbiomed.2015.12.001 ◽

2016 ◽

Vol 69 ◽

pp. 29-36 ◽

Cited By ~ 16

Author(s):

E.A. Ovcharenko ◽

K.U. Klyshnikov ◽

A.E. Yuzhalin ◽

G.V. Savrasov ◽

A.N. Kokov ◽

...

Keyword(s):

Finite Element Analysis ◽

Finite Element ◽

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Patient Specific ◽

Element Analysis ◽

Transcatheter Aortic Valve

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Effects of Choice of Medical Imaging Modalities on a Non-invasive Diagnostic and Monitoring Computational Framework for Patients With Complex Valvular, Vascular, and Ventricular Diseases Who Undergo Transcatheter Aortic Valve Replacement

Frontiers in Bioengineering and Biotechnology ◽

10.3389/fbioe.2021.643453 ◽

2021 ◽

Vol 9 ◽

Author(s):

Melissa Baiocchi ◽

Shirley Barsoum ◽

Seyedvahid Khodaei ◽

Jose M. de la Torre Hernandez ◽

Sydney E. Valentino ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Transcatheter Aortic Valve Replacement ◽

Computational Mechanics ◽

Diagnostic Methods ◽

Patient Specific ◽

Non Invasive ◽

Transcatheter Aortic Valve ◽

Input Parameters

Due to the high individual differences in the anatomy and pathophysiology of patients, planning individualized treatment requires patient-specific diagnosis. Indeed, hemodynamic quantification can be immensely valuable for accurate diagnosis, however, we still lack precise diagnostic methods for numerous cardiovascular diseases including complex (and mixed) valvular, vascular, and ventricular interactions (C3VI) which is a complicated situation made even more challenging in the face of other cardiovascular pathologies. Transcatheter aortic valve replacement (TAVR) is a new less invasive intervention and is a growing alternative for patients with aortic stenosis. In a recent paper, we developed a non-invasive and Doppler-based diagnostic and monitoring computational mechanics framework for C3VI, called C3VI-DE that uses input parameters measured reliably using Doppler echocardiography. In the present work, we have developed another computational-mechanics framework for C3VI (called C3VI-CT). C3VI-CT uses the same lumped-parameter model core as C3VI-DE but its input parameters are measured using computed tomography and a sphygmomanometer. Both frameworks can quantify: (1) global hemodynamics (metrics of cardiac function); (2) local hemodynamics (metrics of circulatory function). We compared accuracy of the results obtained using C3VI-DE and C3VI-CT against catheterization data (gold standard) using a C3VI dataset (N = 49) for patients with C3VI who undergo TAVR in both pre and post-TAVR with a high variability. Because of the dataset variability and the broad range of diseases that it covers, it enables determining which framework can yield the most accurate results. In contrast with C3VI-CT, C3VI-DE tracks both the cardiac and vascular status and is in great agreement with cardiac catheter data.

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