Hoda Hatoum1, Gunnar Askegaard2, Ramji Iyer2, Lakshmi Prasad Dasi3. 1. Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA. 2. R&D Department, LivaNova PLC, Maple Grove, MN, USA. 3. Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, GA, USA.
Abstract
OBJECTIVES: The objective of this study was to evaluate the haemodynamic performance of transcatheter mitral valve replacement (TMVR) Implant with a focus on turbulence and washout adjacent to the ventricular surface of the leaflets. TMVR holds the promise of treating a large spectrum of mitral valve diseases. However, the haemodynamic performance and flow dynamics of such replacements are not fully understood. METHODS: A tri-leaflet biopsrosthetic TMVR represented by Caisson implant of size 36A was implanted in the mitral position of a left heart simulator pulse duplicating system under physiological conditions. The 36A implant covers an anterior-posterior range of 26-32 mm and a commissure-to-commissure range of 30-36 mm. Transmitral pressure gradient, effective orifice area and regurgitant fraction were calculated. Particle image velocimetry was performed to evaluate turbulence in 2 perpendicular planes (Reynolds and viscous shear stresses, respectively). Additionally, dye experiments were performed to visualize washout. RESULTS: Transmitral pressure gradient was 1.29 ± 0.27 mmHg and effective orifice area was 2.96 ± 0.28 cm2. Regurgitant fraction was 14.13 ± 0.08%. Total washout was 4.27 cardiac cycles. Largest viscous shear stress reaches 3.7 Pa and 2.4 Pa in ventricle and atrium, respectively. Reynolds shear stress in the atrial side was <10 Pa. In the ventricular side, the largest Reynolds shear stress reached ∼35 Pa. CONCLUSIONS: TMVR leads to favourable haemodynamics with low degree of turbulence combined with fast washout around the leaflets indicating promising potential for freedom from blood damage potential and thrombosis corroborated by initial clinical studies as part of the valves's Early Feasibility Study.
OBJECTIVES: The objective of this study was to evaluate the haemodynamic performance of transcatheter mitral valve replacement (TMVR) Implant with a focus on turbulence and washout adjacent to the ventricular surface of the leaflets. TMVR holds the promise of treating a large spectrum of mitral valve diseases. However, the haemodynamic performance and flow dynamics of such replacements are not fully understood. METHODS: A tri-leaflet biopsrosthetic TMVR represented by Caisson implant of size 36A was implanted in the mitral position of a left heart simulator pulse duplicating system under physiological conditions. The 36A implant covers an anterior-posterior range of 26-32 mm and a commissure-to-commissure range of 30-36 mm. Transmitral pressure gradient, effective orifice area and regurgitant fraction were calculated. Particle image velocimetry was performed to evaluate turbulence in 2 perpendicular planes (Reynolds and viscous shear stresses, respectively). Additionally, dye experiments were performed to visualize washout. RESULTS: Transmitral pressure gradient was 1.29 ± 0.27 mmHg and effective orifice area was 2.96 ± 0.28 cm2. Regurgitant fraction was 14.13 ± 0.08%. Total washout was 4.27 cardiac cycles. Largest viscous shear stress reaches 3.7 Pa and 2.4 Pa in ventricle and atrium, respectively. Reynolds shear stress in the atrial side was <10 Pa. In the ventricular side, the largest Reynolds shear stress reached ∼35 Pa. CONCLUSIONS: TMVR leads to favourable haemodynamics with low degree of turbulence combined with fast washout around the leaflets indicating promising potential for freedom from blood damage potential and thrombosis corroborated by initial clinical studies as part of the valves's Early Feasibility Study.
Authors: Hyde M Russell; Mayra E Guerrero; Michael H Salinger; Melissa A Manzuk; Amit K Pursnani; Dee Wang; Hassan Nemeh; Rahul Sakhuja; Serguei Melnitchouk; Ashish Pershad; H Kenith Fang; Sameh M Said; James Kauten; Gilbert H L Tang; Gabriel Aldea; Ted E Feldman; Vinnie N Bapat; Isaac M George Journal: J Am Coll Cardiol Date: 2018-09-25 Impact factor: 24.094
Authors: John G Webb; Dale J Murdoch; Robert H Boone; Robert Moss; Adrian Attinger-Toller; Philipp Blanke; Anson Cheung; Mark Hensey; Jonathon Leipsic; Kevin Ong; Janarthanan Sathananthan; David A Wood; Jian Ye; Paolo Tartara Journal: J Am Coll Cardiol Date: 2019-03-26 Impact factor: 24.094
Authors: Olaf Franzen; Stephan Baldus; Volker Rudolph; Sven Meyer; Malgorzata Knap; Dietmar Koschyk; Hendrik Treede; Achim Barmeyer; Joachim Schofer; Angelika Costard-Jäckle; Michael Schlüter; Hermann Reichenspurner; Thomas Meinertz Journal: Eur Heart J Date: 2010-03-10 Impact factor: 29.983
Authors: Vinayak Bapat; Vivek Rajagopal; Christopher Meduri; R Saeid Farivar; Antony Walton; Stephen J Duffy; Robert Gooley; Aubrey Almeida; Michael J Reardon; Neal S Kleiman; Konstantinos Spargias; Stratis Pattakos; Martin K Ng; Michael Wilson; David H Adams; Martin Leon; Michael J Mack; Sharla Chenoweth; Paul Sorajja Journal: J Am Coll Cardiol Date: 2017-11-16 Impact factor: 24.094
Authors: Hoda Hatoum; Milad Samaee; Janarthanan Sathananthan; Stephanie Sellers; Maximilian Kuetting; Scott M Lilly; Abdul R Ihdayhid; Philipp Blanke; Jonathon Leipsic; Vinod H Thourani; Lakshmi Prasad Dasi Journal: JTCVS Open Date: 2022-04-20