Numerical evaluation of transcatheter aortic valve performance during heart beating and its post-deployment fluid-structure interaction analysis
Numerical evaluation of transcatheter aortic valve performance during heart beating and its post-deployment fluid-structure interaction analysis
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DOI：
10.1007/s10237-020-01304-9
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发表时间：
2020-02-24
影响因子：
3.5
通讯作者：
Bluestein, Danny
中科院分区：
文献类型：
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作者：
Ghosh, Ram P.;Marom, Gil;Bluestein, Danny
经导管主动脉瓣置换术（TAVR）是一种微创手术，为治疗晚期钙化性主动脉瓣疾病患者提供了心内直视手术瓣膜置换术的有效替代方案。然而，瓣膜耐久性、器械移位、瓣周漏（PVL）和血栓形成等并发症可能导致TAVR术后总体发病率和死亡率增加。进行了一系列涉及自膨式TAVR瓣膜的数值研究，以评价这些并发症。结构研究进行了有限元（FE）分析，其次是计算流体动力学（CFD）模拟和流体-结构相互作用（FSI）分析。利用有限元分析研究了TAVR瓣膜植入深度对活体心脏人体模型中瓣膜锚固的影响，该模型能够在重复心动周期期间模拟心脏跳动。然后使用未观察到瓣膜移位的TAVR展开病例通过CFD模拟计算展开后血栓形成的可能性。随后进行FSI分析，以进一步评估不同植入深度的展开后TAVR血流动力学性能。比较展开的瓣膜PVL、几何和有效瓣口面积以及瓣叶结构和流动应力大小，以确定器械最佳锚定区。结合结构和血流动力学分析表明，TAVR瓣膜在后心室位置展开时，在所研究的特定解剖结构中实现了最佳性能。鉴于TAVR快速扩展到年轻的低风险患者，本文提出的综合数值方法可能用作手术计划和瓣膜设计优化的预测工具，以最大限度地减少报告的并发症。
Transcatheter aortic valve replacement (TAVR) is a minimally invasive procedure that provides an effective alternative to open-heart surgical valve replacement for treating advanced calcific aortic valve disease patients. However, complications, such as valve durability, device migration, paravalvular leakage (PVL), and thrombogenicity may lead to increased overall post-TAVR morbidity and mortality. A series of numerical studies involving a self-expandable TAVR valve were performed to evaluate these complications. Structural studies were performed with finite element (FE) analysis, followed by computational fluid dynamics (CFD) simulations, and fluid-structure interaction (FSI) analysis. The FE analysis was utilized to study the effect of TAVR valve implantation depth on valve anchorage in the Living Heart Human Model, which is capable of simulating beating heart during repeated cardiac cycles. The TAVR deployment cases where no valve migration was observed were then used to calculate the post-deployment thrombogenic potential via CFD simulations. FSI analysis followed to further assess the post-deployment TAVR hemodynamic performance for different implantation depths. The deployed valves PVL, geometric and effective orifice areas, and the leaflets structural and flow stress magnitudes were compared to determine the device optimal landing zone. The combined structural and hemodynamic analysis indicated that with the TAVR valve deployed at an aft ventricle position an optimal performance was achieved in the specific anatomy studied. Given the TAVR's rapid expansion to younger lower-risk patients, the comprehensive numerical methodology proposed here can potentially be used as a predictive tool for both procedural planning and valve design optimization to minimize the reported complications.