Giorgia Rocatello1, Nahid El Faquir1, Gianluca De Santis1, Francesco Iannaccone1, Johan Bosmans1, Ole De Backer1, Lars Sondergaard1, Patrick Segers1, Matthieu De Beule1, Peter de Jaegere1, Peter Mortier2. 1. From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.). 2. From the IBiTech-bioMMeda, Ghent University, Belgium (G.R., P.S., M.D.B.); Department of Cardiology, Erasmus MC, Rotterdam, the Netherlands (N.E.F., P.d.J.); FEops NV, Ghent, Belgium (G.D.S., F.I., M.D.B., P.M.); University Hospital Antwerp, Belgium (J.B.); and Department of Cardiology, Rigshospitalet University Hospital, Copenhagen, Denmark (O.D.B., L.S.). peter.mortier@feops.com.
Abstract
BACKGROUND: The extent to which pressure generated by the valve on the aortic root plays a role in the genesis of conduction abnormalities after transcatheter aortic valve replacement (TAVR) is unknown. This study elucidates the role of contact pressure and contact pressure area in the development of conduction abnormalities after TAVR using patient-specific computer simulations. METHODS AND RESULTS: Finite-element computer simulations were performed to simulate TAVR of 112 patients who had undergone TAVR with the self-expanding CoreValve/Evolut R valve. On the basis of preoperative multi-slice computed tomography, a patient-specific region of the aortic root containing the atrioventricular conduction system was determined by identifying the membranous septum. Contact pressure and contact pressure index (percentage of area subjected to pressure) were quantified and compared in patients with and without new conduction abnormalities. Sixty-two patients (55%) developed a new left bundle branch block or a high-degree atrioventricular block after TAVR. Maximum contact pressure and contact pressure index (median [interquartile range]) were significantly higher in patients with compared with those without new conduction abnormalities (0.51 MPa [0.43-0.70 MPa] and 33% [22%-44%], respectively, versus 0.29 MPa [0.06-0.50 MPa] and 12% [1%-28%]). By multivariable regression analysis, only maximum contact pressure (odds ratio, 1.35; confidence interval, 1.1-1.7; P=0.01) and contact pressure index (odds ratio, 1.52; confidence interval, 1.1-2.1; P=0.01) were identified as independent predictors for conduction abnormalities, but not implantation depth. CONCLUSIONS: Patient-specific computer simulations revealed that maximum contact pressure and contact pressure index are both associated with new conduction abnormalities after CoreValve/Evolut R implantation and can predict which patient will have conduction abnormalities.
BACKGROUND: The extent to which pressure generated by the valve on the aortic root plays a role in the genesis of conduction abnormalities after transcatheter aortic valve replacement (TAVR) is unknown. This study elucidates the role of contact pressure and contact pressure area in the development of conduction abnormalities after TAVR using patient-specific computer simulations. METHODS AND RESULTS: Finite-element computer simulations were performed to simulate TAVR of 112 patients who had undergone TAVR with the self-expanding CoreValve/Evolut R valve. On the basis of preoperative multi-slice computed tomography, a patient-specific region of the aortic root containing the atrioventricular conduction system was determined by identifying the membranous septum. Contact pressure and contact pressure index (percentage of area subjected to pressure) were quantified and compared in patients with and without new conduction abnormalities. Sixty-two patients (55%) developed a new left bundle branch block or a high-degree atrioventricular block after TAVR. Maximum contact pressure and contact pressure index (median [interquartile range]) were significantly higher in patients with compared with those without new conduction abnormalities (0.51 MPa [0.43-0.70 MPa] and 33% [22%-44%], respectively, versus 0.29 MPa [0.06-0.50 MPa] and 12% [1%-28%]). By multivariable regression analysis, only maximum contact pressure (odds ratio, 1.35; confidence interval, 1.1-1.7; P=0.01) and contact pressure index (odds ratio, 1.52; confidence interval, 1.1-2.1; P=0.01) were identified as independent predictors for conduction abnormalities, but not implantation depth. CONCLUSIONS:Patient-specific computer simulations revealed that maximum contact pressure and contact pressure index are both associated with new conduction abnormalities after CoreValve/Evolut R implantation and can predict which patient will have conduction abnormalities.
Authors: Giorgia Rocatello; Nahid El Faquir; Ole de Backer; Martin J Swaans; Azeem Latib; Luca Vicentini; Patrick Segers; Matthieu De Beule; Peter de Jaegere; Peter Mortier Journal: J Cardiovasc Transl Res Date: 2019-08-23 Impact factor: 4.132
Authors: Jordan A Brown; Jae H Lee; Margaret Anne Smith; David R Wells; Aaron Barrett; Charles Puelz; John P Vavalle; Boyce E Griffith Journal: Ann Biomed Eng Date: 2022-10-20 Impact factor: 4.219
Authors: Justin T Tretter; Shumpei Mori; Robert H Anderson; Michael D Taylor; Nicholas Ollberding; Vien Truong; Joseph Choo; Dean Kereiakes; Wojciech Mazur Journal: Open Heart Date: 2019-04-09
Authors: Nahid El Faquir; Giorgia Rocatello; Zouhair Rahhab; Johan Bosmans; Ole De Backer; Nicolas M Van Mieghem; Peter Mortier; Peter P T de Jaegere Journal: Int J Cardiovasc Imaging Date: 2019-09-12 Impact factor: 2.357
Authors: Ghazaleh Haghiashtiani; Kaiyan Qiu; Jorge D Zhingre Sanchez; Zachary J Fuenning; Priya Nair; Sarah E Ahlberg; Paul A Iaizzo; Michael C McAlpine Journal: Sci Adv Date: 2020-08-28 Impact factor: 14.136