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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Bibliographic Details
Published in:Journal of cardiovascular translational research Vol. 15; no. 4; pp. 834 - 844
Main Authors: Anam, Salwa B., Kovarovic, Brandon J., Ghosh, Ram P., Bianchi, Matteo, Hamdan, Ashraf, Haj-Ali, Rami, Bluestein, Danny
Format: Journal Article
Language:English
Published: New York Springer US 01.08.2022
Subjects:
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
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
ISSN:1937-5387, 1937-5395, 1937-5395
Online Access:Get full text
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Summary: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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Lead Author: Salwa Anam
ISSN:1937-5387
1937-5395
1937-5395
DOI:10.1007/s12265-021-10191-z