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Influence of Patient-Specific Characteristics on Transcatheter Heart Valve Neo-Sinus Flow: An In Silico Study

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Abstract

Thrombosis in post-transcatheter aortic valve replacement (TAVR) patients has been correlated with flow stasis in the neo-sinus. This study investigated the effect of the post-TAVR geometry on flow stasis. Computed tomography angiography of 155 patients who underwent TAVR using a SAPIEN 3 were used to identify patients with and without thrombosis, and quantify thrombus volumes. Six patients with 23-mm SAPIEN 3 valves were then selected from the cohort and used to create patient-specific post-TAVR computational fluid dynamic models. Regions of flow stasis (%Volstasis, velocities below 0.05 m/s) were identified. The results showed that all post-TAVR anatomical measurements were significantly different in patients with and without thrombus, but only sinus diameter had a linear correlation with thrombus volume (r = 0.471, p = 0.008). A linear correlation was observed between %Volstasis and thrombus volume (r = 0.821, p = 0.007). The combination of anatomy and valve deployment created a unique geometry in each patient, which when combined with patient-specific cardiac output, resulted in distinct flow patterns. While parametric studies have shown individual anatomical or deployment metrics may relate to flow stasis, the combined effects of these metrics potentially contributes to the biomechanical environment promoting thrombosis, therefore hemodynamic studies of TAVR should account for these patient-specific factors.

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Abbreviations

AS:

Aortic stenosis

CAD:

Computer aided design

CFD:

Computational fluid dynamics

CO:

Cardiac output

CTA:

Computed tomography angiography

FSI:

Fluid–structure interaction

HALT:

Hypo-attenuated leaflet thickening

LCA:

Left coronary artery

LVOT:

Left ventricular outflow tract

PIV:

Particle image velocimetry

PLM:

Parametric leaflet model

RCA:

Right coronary artery

SOV:

Sinus of Valsalva

STJ:

Sinotubular junction

TAV:

Transcatheter aortic valve

TAVR:

Transcatheter aortic valve replacement

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Acknowledgments

This study was supported with funds from the Wallace H. Coulter Chair Endowment and the Marvin H. and Rita Floyd Endowment. Beatrie Ncho also holds an International Fellowship from American Association of University Women. The authors acknowledge the use of ANSYS software which was provided through an Academic Partnership between ANSYS, Inc.; the Cardiovascular Fluid Mechanics Laboratory at Georgia Tech, particularly Mandy Salmon and Joe Kun Huck Choi; and Ming-Chen Hsu and Fei Xu from Iowa State University for their assistance with the parametric leaflet modeling.

Conflicts of interest

Philipp Blanke is a Consultant for Edwards Lifesciences, Tendyne, Neovasc and Circle Cardiovascular Imaging. Ajit Yoganathan is a Consultant or Researcher for St. Jude Medical, Boston Scientific, Sorin Biomedica and Edwards Lifesciences. The other authors have nothing to disclose.

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Authors and Affiliations

  1. The Wallace H. Coulter School of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA

    Shelly Singh-Gryzbon, Beatrice Ncho, Vahid Sadri, Sanchita S. Bhat, Sai S. Kollapaneni, Dharani Balakumar, Zhenglun A. Wei & Ajit P. Yoganathan

  2. Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany

    Philipp Ruile & Franz-Joseph Neumann

  3. Department of Radiology, St Paul’s Hospital and University of British Columbia, Vancouver, BC, Canada

    Philipp Blanke

  4. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Technology Enterprise Park, 387 Technology Circle NW, Atlanta, GA, 30313-2412, USA

    Ajit P. Yoganathan

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  1. Shelly Singh-Gryzbon
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  2. Beatrice Ncho
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  3. Vahid Sadri
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  4. Sanchita S. Bhat
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  11. Ajit P. Yoganathan
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Correspondence to Ajit P. Yoganathan.

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Singh-Gryzbon, S., Ncho, B., Sadri, V. et al. Influence of Patient-Specific Characteristics on Transcatheter Heart Valve Neo-Sinus Flow: An In Silico Study. Ann Biomed Eng 48, 2400–2411 (2020). https://doi.org/10.1007/s10439-020-02532-x

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