Assessment of Paravalvular Leak Severity and Thrombogenic Potential in Transcatheter Bicuspid Aortic Valve Replacements Using Patient-Specific Computational Modeling
Bicuspid aortic valve (BAV), the most common congenital valvular abnormality, generates asymmetric flow patterns and increased stresses on the leaflets that expedite valvular calcification and structural degeneration. Recently adapted for use in BAV patients, TAVR demonstrates promising performance,...
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| Vydané v: | Journal of cardiovascular translational research Ročník 15; číslo 4; s. 834 - 844 |
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| Hlavní autori: | , , , , , , |
| Médium: | Journal Article |
| Jazyk: | English |
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New York
Springer US
01.08.2022
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| ISSN: | 1937-5387, 1937-5395, 1937-5395 |
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| Abstract | Bicuspid aortic valve (BAV), the most common congenital valvular abnormality, generates asymmetric flow patterns and increased stresses on the leaflets that expedite valvular calcification and structural degeneration. Recently adapted for use in BAV patients, TAVR demonstrates promising performance, but post-TAVR complications tend to get exacerbated due to BAV anatomical complexities. Utilizing patient-specific computational modeling, we address some of these complications. The degree and location of post-TAVR PVL was assessed, and the risk of flow-induced thrombogenicity was analyzed in 3 BAV patients — using older generation TAVR devices that were implanted in these patients, and compared them to the performance of the newest generation TAVR devices using in silico patient models. Significant decrease in PVL and thrombogenic potential was observed after implantation of the newest generation device. The current work demonstrates the potential of using simulations in pre-procedural planning to assess post-TAVR complications, and compare the performance of different device
s
to achieve better clinical outcomes.
Graphical abstract
Patient-specific computational framework to assess post-transcatheter bicuspid aortic valve replacement paravalvular leakage and flow-induced thrombogenic complications and compare device performances. |
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| AbstractList | Bicuspid aortic valve (BAV), the most common congenital valvular abnormality, generates asymmetric flow patterns and increased stresses on the leaflets that expedite valvular calcification and structural degeneration. Recently adapted for use in BAV patients, TAVR demonstrates promising performance, but post-TAVR complications tend to get exacerbated due to BAV anatomical complexities. Utilizing patient-specific computational modeling, we address some of these complications. The degree and location of post-TAVR PVL was assessed, and the risk of flow-induced thrombogenicity was analyzed in 3 BAV patients - using older generation TAVR devices that were implanted in these patients, and compared them to the performance of the newest generation TAVR devices using in silico patient models. Significant decrease in PVL and thrombogenic potential was observed after implantation of the newest generation device. The current work demonstrates the potential of using simulations in pre-procedural planning to assess post-TAVR complications, and compare the performance of different devices to achieve better clinical outcomes. Patient-specific computational framework to assess post-transcatheter bicuspid aortic valve replacement paravalvular leakage and flow-induced thrombogenic complications and compare device performances.Bicuspid aortic valve (BAV), the most common congenital valvular abnormality, generates asymmetric flow patterns and increased stresses on the leaflets that expedite valvular calcification and structural degeneration. Recently adapted for use in BAV patients, TAVR demonstrates promising performance, but post-TAVR complications tend to get exacerbated due to BAV anatomical complexities. Utilizing patient-specific computational modeling, we address some of these complications. The degree and location of post-TAVR PVL was assessed, and the risk of flow-induced thrombogenicity was analyzed in 3 BAV patients - using older generation TAVR devices that were implanted in these patients, and compared them to the performance of the newest generation TAVR devices using in silico patient models. Significant decrease in PVL and thrombogenic potential was observed after implantation of the newest generation device. The current work demonstrates the potential of using simulations in pre-procedural planning to assess post-TAVR complications, and compare the performance of different devices to achieve better clinical outcomes. Patient-specific computational framework to assess post-transcatheter bicuspid aortic valve replacement paravalvular leakage and flow-induced thrombogenic complications and compare device performances. Bicuspid aortic valve (BAV), the most common congenital valvular abnormality, generates asymmetric flow patterns and increased stresses on the leaflets that expedite valvular calcification and structural degeneration. Recently adapted for use in BAV patients, TAVR demonstrates promising performance, but post-TAVR complications tend to get exacerbated due to BAV anatomical complexities. Utilizing patient-specific computational modeling, we address some of these complications. The degree and location of post-TAVR PVL was assessed, and the risk of flow-induced thrombogenicity was analyzed in 3 BAV patients — using older generation TAVR devices that were implanted in these patients, and compared them to the performance of the newest generation TAVR devices using in silico patient models. Significant decrease in PVL and thrombogenic potential was observed after implantation of the newest generation device. The current work demonstrates the potential of using simulations in pre-procedural planning to assess post-TAVR complications, and compare the performance of different device s to achieve better clinical outcomes. Graphical abstract Patient-specific computational framework to assess post-transcatheter bicuspid aortic valve replacement paravalvular leakage and flow-induced thrombogenic complications and compare device performances. BAV, the most common congenital valvular abnormality, generate asymmetric flow patterns and increased stresses on the leaflets that expedite valvular calcification and structural degeneration. Recently adapted for use in BAV patients, TAVR demonstrates promising performance, but post-TAVR complications tend to get exacerbated due to BAV anatomical complexities. Utilizing patient-specific computational modeling we address some of these complications. The degree and location of post-TAVR PVL was assessed and the risk of flow-induced thrombogenicity was analyzed in 3 BAV patients − using older generation TAVR devices that were implanted in these patients, and compared them to the performance of the newest generation TAVR devices using in-silico patient models. Significant decrease in PVL and thrombogenic potential was observed after implantation of the newest generation device. The current work demonstrates the potential of using simulations in pre-procedural planning to assess post-TAVR complicaitons, and compare the performance of different devices to achieve better clinical outcomes. Patient-specific computational framework to assess post-transcatheter bicuspid aortic valve replacement paravalvular leakage and flow-induced thrombogenic complications and compare device performances Bicuspid aortic valve (BAV), the most common congenital valvular abnormality, generates asymmetric flow patterns and increased stresses on the leaflets that expedite valvular calcification and structural degeneration. Recently adapted for use in BAV patients, TAVR demonstrates promising performance, but post-TAVR complications tend to get exacerbated due to BAV anatomical complexities. Utilizing patient-specific computational modeling, we address some of these complications. The degree and location of post-TAVR PVL was assessed, and the risk of flow-induced thrombogenicity was analyzed in 3 BAV patients - using older generation TAVR devices that were implanted in these patients, and compared them to the performance of the newest generation TAVR devices using in silico patient models. Significant decrease in PVL and thrombogenic potential was observed after implantation of the newest generation device. The current work demonstrates the potential of using simulations in pre-procedural planning to assess post-TAVR complications, and compare the performance of different devices to achieve better clinical outcomes. Patient-specific computational framework to assess post-transcatheter bicuspid aortic valve replacement paravalvular leakage and flow-induced thrombogenic complications and compare device performances. |
| Author | Ghosh, Ram P. Haj-Ali, Rami Hamdan, Ashraf Kovarovic, Brandon J. Bluestein, Danny Bianchi, Matteo Anam, Salwa B. |
| AuthorAffiliation | 3 School of Mechanical Engineering, Tel-Aviv University, Tel-Aviv, Israel 2 Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel 1 Biofluids Research Group, Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA |
| AuthorAffiliation_xml | – name: 2 Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel-Aviv University, Tel-Aviv, Israel – name: 3 School of Mechanical Engineering, Tel-Aviv University, Tel-Aviv, Israel – name: 1 Biofluids Research Group, Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA |
| Author_xml | – sequence: 1 givenname: Salwa B. surname: Anam fullname: Anam, Salwa B. organization: Biofluids Research Group, Department of Biomedical Engineering, Stony Brook University – sequence: 2 givenname: Brandon J. surname: Kovarovic fullname: Kovarovic, Brandon J. organization: Biofluids Research Group, Department of Biomedical Engineering, Stony Brook University – sequence: 3 givenname: Ram P. surname: Ghosh fullname: Ghosh, Ram P. organization: Biofluids Research Group, Department of Biomedical Engineering, Stony Brook University – sequence: 4 givenname: Matteo surname: Bianchi fullname: Bianchi, Matteo organization: Biofluids Research Group, Department of Biomedical Engineering, Stony Brook University – sequence: 5 givenname: Ashraf surname: Hamdan fullname: Hamdan, Ashraf organization: Department of Cardiology, Rabin Medical Center – sequence: 6 givenname: Rami surname: Haj-Ali fullname: Haj-Ali, Rami organization: School of Mechanical Engineering, Faculty of Engineering, Tel-Aviv University – sequence: 7 givenname: Danny orcidid: 0000-0002-4014-2308 surname: Bluestein fullname: Bluestein, Danny email: danny.bluestein@stonybrook.edu organization: Biofluids Research Group, Department of Biomedical Engineering, Stony Brook University |
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| Cites_doi | 10.1093/ehjci/jex258 10.1016/j.jcin.2019.07.032 10.1155/2012/145202 10.1016/j.jaccas.2019.10.013 10.1016/j.jcin.2018.10.005 10.1136/openhrt-2019-001164 10.1007/s10237-018-1094-8 10.21037/jtd.2020.01.10 10.1016/j.jtcvs.2016.05.023 10.1161/CIRCULATIONAHA.120.048048 10.1016/j.jbiomech.2010.04.020 10.1001/jama.2019.7108 10.1016/j.jcin.2020.03.022 10.1038/s41598-020-66899-6 10.1007/s11517-020-02138-4 10.1016/j.cpcardiol.2005.06.002 10.20517/2574-1209.2018.39 10.1007/s10237-014-0583-7 10.1371/journal.pone.0032463 10.1115/1.4040457 10.1111/aor.12806 10.1161/CIRCULATIONAHA.119.040333 10.1002/jbm.a.34099 10.1016/j.jcin.2016.01.003 10.1136/heart.83.1.81 10.1016/j.jcmg.2015.01.008 10.1001/jama.2019.7525 10.1016/j.jacc.2020.07.005 10.1098/rsif.2019.0893 10.1115/1.4026254 10.1016/s0140-6736(15)60308-7 10.1155/2020/2582938 10.21037/cdt.2019.09.12 10.1007/s10439-020-02571-4 10.1007/s11517-019-02012-y |
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| Keywords | Thrombogenicity Computational fluid dynamics (CFD) Paravalvular leakage (PVL) Transcatheter aortic valve replacement (TAVR) Bicuspid aortic valve (BAV) Transcatheter aortic valve implantation (TAVI) Patient-specific computational modeling |
| Language | English |
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| PublicationTitle | Journal of cardiovascular translational research |
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| SubjectTerms | Aortic Valve - diagnostic imaging Aortic Valve - surgery Aortic Valve Stenosis - surgery Bicuspid Aortic Valve Disease Biomedical Engineering and Bioengineering Biomedicine Cardiology Computer Simulation Human Genetics Humans Medicine Medicine & Public Health Original Article Patient-Specific Modeling Transcatheter Aortic Valve Replacement - adverse effects Treatment Outcome |
| Title | Assessment of Paravalvular Leak Severity and Thrombogenic Potential in Transcatheter Bicuspid Aortic Valve Replacements Using Patient-Specific Computational Modeling |
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