Phillip M Trusty1, Sanchita S Bhat1, Vahid Sadri1, Md Tausif Salim2, Emelia Funnell1, Norihiko Kamioka3, Rahul Sharma4, Raj Makkar5, Vasilis Babaliaros3, Ajit P Yoganathan6. 1. Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga. 2. School of Chemical and Biomolecular Engineering, Georgia Institute of Technology, Atlanta, Ga. 3. Emory University School of Medicine, Atlanta, Ga. 4. Stanford Healthcare, Palo Alto, Calif. 5. Cedars Sinai Heart Institute, Los Angeles, Calif. 6. Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga. Electronic address: ajit.yoganathan@bme.gatech.edu.
Abstract
OBJECTIVE: With the recent expanded indication for transcatheter aortic valve replacement to low-risk surgical patients, thrombus formation in the neosinus is of particular interest due to concerns of reduced leaflet motion and long-term transcatheter heart valve durability. Although flow stasis likely plays a role, a direct connection between neosinus flow stasis and thrombus severity is yet to be established. METHODS: Patients (n = 23) were selected to minimize potential confounding factors related to thrombus formation. Patient-specific 3-dimensional reconstructed in vitro models were created to replicate in vivo anatomy and valve deployment using the patient-specific cardiac output and idealized coronary flows. Dye was injected into each neosinus to quantify washout time as a measure of flow stasis. RESULTS: Flow stasis (washout time) showed a significant, positive correlation with thrombus volume in the neosinus (rho = 0.621, P < .0001). Neither thrombus volume nor washout time was significantly different in the left, right, and noncoronary neosinuses (P ≥ .54). CONCLUSIONS: This is the first patient-specific study correlating flow stasis with thrombus volume in the neosinus post-transcatheter aortic valve replacement across multiple valve types and sizes. Neosinus-specific factors create hemodynamic and thrombotic variability within individual patients. Measurement of neosinus flow stasis may guide strategies to improve outcomes in transcatheter aortic valve replacement.
OBJECTIVE: With the recent expanded indication for transcatheter aortic valve replacement to low-risk surgical patients, thrombus formation in the neosinus is of particular interest due to concerns of reduced leaflet motion and long-term transcatheter heart valve durability. Although flow stasis likely plays a role, a direct connection between neosinus flow stasis and thrombus severity is yet to be established. METHODS: Patients (n = 23) were selected to minimize potential confounding factors related to thrombus formation. Patient-specific 3-dimensional reconstructed in vitro models were created to replicate in vivo anatomy and valve deployment using the patient-specific cardiac output and idealized coronary flows. Dye was injected into each neosinus to quantify washout time as a measure of flow stasis. RESULTS: Flow stasis (washout time) showed a significant, positive correlation with thrombus volume in the neosinus (rho = 0.621, P < .0001). Neither thrombus volume nor washout time was significantly different in the left, right, and noncoronary neosinuses (P ≥ .54). CONCLUSIONS: This is the first patient-specific study correlating flow stasis with thrombus volume in the neosinus post-transcatheter aortic valve replacement across multiple valve types and sizes. Neosinus-specific factors create hemodynamic and thrombotic variability within individual patients. Measurement of neosinus flow stasis may guide strategies to improve outcomes in transcatheter aortic valve replacement.
Authors: Matthew H Park; Yuanjia Zhu; Annabel M Imbrie-Moore; Hanjay Wang; Mateo Marin-Cuartas; Michael J Paulsen; Y Joseph Woo Journal: Front Cardiovasc Med Date: 2021-07-08