Francesco Nappi1, Laura Mazzocchi2, Cristiano Spadaccio3, David Attias4, Irina Timofeva5, Laurent Macron5, Adelaide Iervolino6, Simone Morganti7, Ferdinando Auricchio2. 1. Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint Denis, France. 2. Department of Civil Engineering and Architecture, University of Pavia, 27100 Pavia, Italy. 3. Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G12 8QQ, UK. 4. Department of Cardiology, Centre Cardiologique du Nord, 93200 Saint Denis, France. 5. Department of Imaging, Centre Cardiologique du Nord, 93200 Saint Denis, France. 6. Department of Cardiovascular Sciences, Fondazione Policlinico Universitario A. Gemelli IRCSS, 00168 Rome, Italy. 7. Department of Electrical, Computer, and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy.
Abstract
AIM: to investigate the factors implied in the development of postoperative complications in both self-expandable and balloon-expandable transcatheter heart valves by means of finite element analysis (FEA). MATERIALS AND METHODS: FEA was integrated into CT scans to investigate two cases of postoperative device failure for valve thrombosis after the successful implantation of a CoreValve and a Sapien 3 valve. Data were then compared with two patients who had undergone uncomplicated transcatheter heart valve replacement (TAVR) with the same types of valves. RESULTS: Computational biomechanical modeling showed calcifications persisting after device expansion, not visible on the CT scan. These calcifications determined geometrical distortion and elliptical deformation of the valve predisposing to hemodynamic disturbances and potential thrombosis. Increased regional stress was also identified in correspondence to the areas of distortion with the associated paravalvular leak. CONCLUSION: the use of FEA as an adjunct to preoperative imaging might assist patient selection and procedure planning as well as help in the detection and prevention of TAVR complications.
AIM: to investigate the factors implied in the development of postoperative complications in both self-expandable and balloon-expandable transcatheter heart valves by means of finite element analysis (FEA). MATERIALS AND METHODS: FEA was integrated into CT scans to investigate two cases of postoperative device failure for valve thrombosis after the successful implantation of a CoreValve and a Sapien 3 valve. Data were then compared with two patients who had undergone uncomplicated transcatheter heart valve replacement (TAVR) with the same types of valves. RESULTS: Computational biomechanical modeling showed calcifications persisting after device expansion, not visible on the CT scan. These calcifications determined geometrical distortion and elliptical deformation of the valve predisposing to hemodynamic disturbances and potential thrombosis. Increased regional stress was also identified in correspondence to the areas of distortion with the associated paravalvular leak. CONCLUSION: the use of FEA as an adjunct to preoperative imaging might assist patient selection and procedure planning as well as help in the detection and prevention of TAVR complications.
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