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Numerical models of valve-in-valve implantation: effect of intentional leaflet laceration on the anchorage.
Biomechanics and Modeling in Mechanobiology ( IF 3.0 ) Pub Date : 2019-08-30 , DOI: 10.1007/s10237-019-01218-1
Halit Yaakobovich 1 , Romina Plitman Mayo 2 , Uri Zaretsky 1 , Ariel Finkelstein 3 , Gil Marom 2
Affiliation  

Transcatheter aortic valve implantation (TAVI) is currently recommended in practice guidelines for patients who are at intermediate to high surgical risk for surgical aortic valve replacement. Coronary artery obstruction is a fatal complication of TAVI that occurs in up to 3.5% of the implantations inside a failed surgical bioprosthetic valve (valve-in-valve, ViV). A new technique to address this problem is intentional laceration of the bioprosthetic leaflets, known as BASILICA. In this technique, the leaflets are lacerated to prevent coronary obstruction and may also help in preventing leaflet thrombosis. Our hypothesis is that this technique may harm the circumferential stress in the surgical valve and weaken the anchorage of the TAVI device. This study aims to compare the anchorage post-ViV implantations, with and without lacerations, using numerical modelling. Deployments of TAVI stents (Medtronic Evolut PRO; Edwards SAPIEN 3) inside an externally mounted surgical bioprosthetic valve (Sorin Mitroflow) were modelled by finite element analysis. The results show that each laceration reduces the contact area of the TAVI stent with its landing zone and that the anchorage contact force weakens. The BASILICA technique has lesser effect on the anchorage contact area and forces in the SAPIEN than in the Evolut cases, because the balloon inflation is less sensitive to the deployment region. TAVI stent migration was not found in any of the models. These results can help expanding the use of leaflet laceration by choosing a better matched TAVI devices for the BASILICA technique.

中文翻译:

瓣膜植入的数值模型:故意瓣叶撕裂对锚固的影响。

在实践指南中,目前建议将导管主动脉瓣植入术(TAVI)用于处于中等或高手术主动脉瓣置换风险的患者。冠状动脉阻塞是TAVI的致命并发症,发生在外科手术生物人工瓣膜(瓣膜内瓣膜,ViV)内最多3.5%的植入物中。解决此问题的新技术是故意将生物修复小叶撕裂,称为BASILICA。在该技术中,将小叶割裂以防止冠状动脉阻塞,也可能有助于防止小叶血栓形成。我们的假设是,该技术可能会损害手术瓣膜的周向应力并削弱TAVI设备的固定。这项研究的目的是比较ViV植入后有无裂伤的情况,使用数值建模。通过有限元分析对TAVI支架(Medtronic Evolut PRO; Edwards SAPIEN 3)在外部安装的外科生物人工瓣膜(Sorin Mitroflow)中的部署进行建模。结果表明,每次撕裂都会减小TAVI支架与其着陆区的接触面积,并且锚固接触力会减弱。与Evolut案例相比,BASILICA技术对SAPIEN中的锚固接触面积和力的影响较小,因为气球膨胀对展开区域较不敏感。在任何模型中均未发现TAVI支架迁移。这些结果可通过为BASILICA技术选择更匹配的TAVI设备来帮助扩大小叶撕裂伤的使用范围。通过有限元分析对外部安装的外科生物人工瓣膜(Sorin Mitroflow)内部的Edwards SAPIEN 3)进行建模。结果表明,每次撕裂都会减小TAVI支架与其着陆区的接触面积,并且锚固接触力会减弱。与Evolut案例相比,BASILICA技术对SAPIEN中的锚固接触面积和力的影响较小,因为气球膨胀对展开区域较不敏感。在任何模型中均未发现TAVI支架迁移。这些结果可通过为BASILICA技术选择更匹配的TAVI设备来帮助扩大小叶撕裂伤的使用范围。通过有限元分析对外部安装的外科生物人工瓣膜(Sorin Mitroflow)内部的Edwards SAPIEN 3)进行建模。结果表明,每次撕裂都会减小TAVI支架与其着陆区的接触面积,并且锚固接触力会减弱。与Evolut案例相比,BASILICA技术对SAPIEN中的锚固接触面积和力的影响较小,因为气球膨胀对展开区域较不敏感。在任何模型中均未发现TAVI支架迁移。这些结果可通过为BASILICA技术选择更匹配的TAVI设备来帮助扩大小叶撕裂伤的使用范围。结果表明,每次撕裂都会减小TAVI支架与其着陆区的接触面积,并且锚固接触力会减弱。与Evolut案例相比,BASILICA技术对SAPIEN中的锚固接触面积和力的影响较小,因为气球膨胀对展开区域较不敏感。在任何模型中均未发现TAVI支架迁移。这些结果可通过为BASILICA技术选择更匹配的TAVI设备来帮助扩大小叶撕裂伤的使用范围。结果表明,每次撕裂都会减小TAVI支架与其着陆区的接触面积,并且锚固接触力会减弱。与Evolut案例相比,BASILICA技术对SAPIEN中的锚固接触区域和力的影响较小,因为气球膨胀对展开区域较不敏感。在任何模型中均未发现TAVI支架迁移。这些结果可通过为BASILICA技术选择更匹配的TAVI设备来帮助扩大小叶撕裂伤的使用范围。
更新日期:2019-08-30
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