Sealing Behavior in Transcatheter Bicuspid and Tricuspid Aortic Valves Replacement Through Patient-Specific Computational Modeling

Background: Patient-specific computer simulation of transcatheter aortic valve replacement (TAVR) can provide unique insights in device-patient interaction.Aims: This study was to compare transcatheter aortic valve sealing behavior in patients with bicuspid aortic valves (BAV) and tricuspid aortic valves (TAV) through patient-specific computational modeling.Methods: Patient-specific computer simulation was retrospectively performed with FEops HEARTguide for TAVR patients. Simulation output was compared with postprocedural computed tomography and echocardiography to validate the accuracy. Skirt malapposition was defined by a distance larger than 1 mm based on the predicted device-patient interaction by quantifying the distance between the transcatheter heart valve (THV) skirt and the surrounding anatomical regions.Results: In total, 43 patients were included in the study. Predicted and observed THV frame deformation showed good correlation (R2 ≥ 0.90) for all analyzed measurements (maximum diameter, minimum diameter, area, and perimeter). The amount of predicted THV skirt malapposition was strongly linked with the echocardiographic grading of paravalvular leakage (PVL). More THV skirt malapposition was observed for BAV cases when compared to TAV cases (22.7 vs. 15.5%, p < 0.05). A detailed analysis of skirt malapposition showed a higher degree of malapposition in the interleaflet triangles section for BAV cases as compared to TAV patients (11.1 vs. 5.8%, p < 0.05).Conclusions: Patient-specific computer simulation of TAVR can accurately predict the behavior of the Venus A-valve. BAV patients are associated with more malapposition of the THV skirt as compared to TAV patients, and this is mainly driven by more malapposition in the interleaflet triangle region.

Download Full-text

Patient-specific Computer Simulation: An Emerging Technology for Guiding the Transcatheter Treatment of Patients with Bicuspid Aortic Valve

Interventional Cardiology Review ◽

10.15420/icr.2021.09 ◽

2021 ◽

Vol 16 ◽

Author(s):

Cameron Dowling ◽

Robert Gooley ◽

Liam McCormick ◽

Sami Firoozi ◽

Stephen J Brecker

Keyword(s):

Computer Simulation ◽

Aortic Valve ◽

Clinical Outcomes ◽

Bicuspid Aortic Valve ◽

Patient Specific ◽

Transcatheter Aortic Valve ◽

Anatomical Basis ◽

Transcatheter Heart Valve ◽

Risk Patients ◽

Valve Implantation

Transcatheter aortic valve implantation (TAVI) is increasingly being used to treat younger, lower-risk patients, many of whom have bicuspid aortic valve (BAV). As TAVI begins to enter these younger patient cohorts, it is critical that clinical outcomes from TAVI in BAV are matched to those achieved by surgery. Therefore, the identification of patients who, on an anatomical basis, may not be suitable for TAVI, would be desirable. Furthermore, clinical outcomes of TAVI in BAV might be improved through improved transcatheter heart valve sizing and positioning. One potential solution to these challenges is patient-specific computer simulation. This review presents the methodology and clinical evidence surrounding patient-specific computer simulation of TAVI in BAV.

Download Full-text

A validated methodology for patient specific computational modeling of self-expandable transcatheter aortic valve implantation

Journal of Biomechanics ◽

10.1016/j.jbiomech.2016.06.024 ◽

2016 ◽

Vol 49 (13) ◽

pp. 2824-2830 ◽

Cited By ~ 18

Author(s):

Bart Bosmans ◽

Nele Famaey ◽

Eva Verhoelst ◽

Johan Bosmans ◽

Jos Vander Sloten

Keyword(s):

Aortic Valve ◽

Computational Modeling ◽

Transcatheter Aortic Valve Implantation ◽

Patient Specific ◽

Transcatheter Aortic Valve ◽

Aortic Valve Implantation ◽

Valve Implantation

Download Full-text

Prosthesis choice for transcatheter aortic valve replacement: Improved outcomes with the adoption of a patient-specific transcatheter heart valve selection algorithm

International Journal of Cardiology ◽

10.1016/j.ijcard.2015.11.105 ◽

2016 ◽

Vol 203 ◽

pp. 1009-1010 ◽

Cited By ~ 4

Author(s):

Marco Barbanti ◽

Sebastiano Immè ◽

Yohei Ohno ◽

Simona Gulino ◽

Denise Todaro ◽

...

Keyword(s):

Aortic Valve ◽

Aortic Valve Replacement ◽

Valve Replacement ◽

Heart Valve ◽

Transcatheter Aortic Valve Replacement ◽

Patient Specific ◽

Selection Algorithm ◽

Transcatheter Aortic Valve ◽

Improved Outcomes ◽

Transcatheter Heart Valve

Download Full-text

Valve-in-Valve-in-Valve: Degenerated Transcatheter Heart Valve within Degenerated Surgical Bioprosthetic Aortic Valve Treated with Second Transcatheter Heart Valve

Reports ◽

10.3390/reports3020007 ◽

2020 ◽

Vol 3 (2) ◽

pp. 7

Author(s):

Muhammad Ajmal ◽

Sridhar Reddy ◽

Ranjith Shetty ◽

Toshinobu Kazui ◽

Kapildeo Lotun

Keyword(s):

Cardiopulmonary Bypass ◽

Aortic Valve ◽

Heart Valve ◽

Rare Case ◽

Aortic Valves ◽

Safety And Efficacy ◽

Hemodynamic Support ◽

Transcatheter Aortic Valve ◽

Transcatheter Heart Valve ◽

Valve In Valve

Currently, transcatheter aortic valve replacements within degenerated surgical bioprosthetic aortic valves (valve in valve) are increasing in frequency with studies supporting their safety and efficacy. We present the rare case of a patient requiring a second transcatheter bioprosthetic aortic valve placed within a previously placed degenerated transcatheter aortic valve, which was implanted in a degenerated surgical bioprosthetic aortic valve. The procedure was performed using a percutaneous cardiopulmonary bypass with TandemLife for hemodynamic support.

Download Full-text

Computed tomography for the prediction of structural valve deterioration in patients undergoing transcatheter aortic valve implantation

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa356.228 ◽

2021 ◽

Vol 22 (Supplement_1) ◽

Author(s):

M Guglielmo ◽

L Fusini ◽

M Muratori ◽

G Tamborini ◽

V Mantegazza ◽

...

Keyword(s):

Computed Tomography ◽

Aortic Valve ◽

Transcatheter Aortic Valve Implantation ◽

Maximum Diameter ◽

Minimum Diameter ◽

Female Sex ◽

Transcatheter Aortic Valve ◽

Structural Valve Deterioration ◽

Aortic Valve Implantation ◽

Valve Implantation

Abstract Funding Acknowledgements Type of funding sources: None. Background Computed tomography (CT) provides excellent anatomy assessment of the aortic annulus (AoA) and is currently routinely utilized for pre-procedural planning of transcatheter aortic valve implantation (TAVI). This study sought to investigate if geometrical characteristics of the AoA determined by CT may represent predictors of structural valve deterioration (SVD) in patients undergoing transcatheter aortic implantation (TAVI) with balloon-expandable valves. Methods AoA maximum diameter (Dmax), minimum diameter (Dmin), and area were assessed using pre-procedural CT in patients undergoing TAVI in our Institution. SVD was identified with transthoracic echocardiography at 5.9 ± 1.7 follow-up years. Results 124 consecutive patients (mean age: 79 ± 7 years old; female: 61%) were retrospectively enrolled. AoA Dmax, Dmin and area were significantly smaller in patients with SVD compared to patients without SVD (27.1 ± 2.8 mm vs 25.6 ± 2.2 mm, p = 0.012; 21.8 ± 2.1 mm vs 20.5 ± 2.1 mm, p = 0.001 and 467 ± 88 mm2 vs 419 ± 77 mm2 p = 0.002 respectively). At univariate analysis, female sex, body surface area, the use of a -23 mm prosthetic valve a Dmax <27.1 mm and a Dmin < 19.9 mm were all variables independently associated with SVD whereas at multivariate analysis, only Dmin <19.9 mm (OR = 2.873, 95% CI: 1.191-6.929, p = 0.019) and female sex (OR = 2.659, 95% CI: 1.095-6.458, p = 0.031) were independent predictors of SVD. Conclusions Female sex and AoA Dmin < 19.9 mm are associated to SVD in patients undergoing TAVI with balloon explandable valves. Abstract Figure.

Download Full-text

Computational Analysis of Self-Expanding and Balloon-Expandable Transcatheter Heart Valves

Biomechanics ◽

10.3390/biomechanics1010004 ◽

2021 ◽

Vol 1 (1) ◽

pp. 43-52

Author(s):

Salvatore Pasta ◽

Caterina Gandolfo

Keyword(s):

Aortic Valve ◽

Heart Valves ◽

Numerical Study ◽

Flow Analysis ◽

Patient Specific ◽

Area At Risk ◽

Virtual Planning ◽

Local Maxima ◽

Transcatheter Aortic Valve ◽

Transcatheter Heart Valve

Bicuspid aortic valve (BAV) patients are usually excluded from transcatheter aortic valve implantation (TAVI) as this valve anatomy likely leads to oval expansion. This study presents a numerical study of TAVI using both self-expanding and balloon expandable transcatheter heart valve (THV) in bicuspid patients with severe stenosis. The simulation framework included a patient-specific anatomy of the aortic root, calcifications and BAV leaflets extracted from medical imaging analysis as well as a realistic crimping and deployment of the THV. Tissue stress analysis highlighted local maxima in the contact area between the inner aortic lumen and the THV stent frame. Flow analysis based on the smoothed particle hydrodynamics (SPH) technique displayed the area at risk of paravalvular leakage (PVL). These findings provide insights on the TAVI in BAV and thus represents a further step towards the use of in-silico for the virtual planning of TAVI, aiming at improving not only the efficacy of the implantation but also the exploration of borderline anatomy as the case of TAVI in BAVs.

Download Full-text