Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study.
Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study.
复制标题
了解TAVR设备的扩展与双质主动脉瓣的形态有关：一项仿真研究。
DOI：
10.1371/journal.pone.0251579
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发表时间：
2021
期刊：
影响因子：
3.7
通讯作者：
Nezami FR
中科院分区：
文献类型：
--
作者：
Kusner J;Luraghi G;Khodaee F;Rodriguez Matas JF;Migliavacca F;Edelman ER;Nezami FR
二叶式主动脉瓣（BAV）是一种常见的异质性先天性心脏病，常合并主动脉瓣狭窄。尽管最初开发用于三尖瓣主动脉瓣（TAV），但经导管主动脉瓣置换术（TAVR）器械越来越多地应用于BAV狭窄的治疗。已知TAVR和BAV之间的患者-器械关系不等同于TAV中观察到的患者-器械关系，但这些差异的性质尚不清楚。我们试图更好地了解TAVR器械与两种最常见的BAV形态之间的患者-器械关系。我们对TAVR在3例理想主动脉解剖结构（TAV、Sievers 0 BAV、Sievers 1 BAV）中展开进行了有限元模拟，这些解剖结构来自患者特定测量值。主动脉瓣接合处的瓣叶von Mises应力因瓣膜配置而异，相差10倍（TAV：0.55 MPa，Sievers 0：6.64 MPa，Sievers 1：4.19 MPa）。与TAV（0.056 MPa）相比，Sievers 1（0.316 MPa）和Sievers 0 BAV（0.137 MPa）中主动脉壁的第一主应力更大。Sievers 1 BAV中的TAVR置入证明了显著的器械不对称对线，在瓣环和瓣叶自由边缘处测量的器械中心之间的位移为1.09 mm。TAV（0.33 mm）中的瓣口位移很小，Sievers 0 BAV（0.23 mm）中的瓣口位移甚至更小。与TAV展开相比，BAV TAVR（取决于所涉及的亚型）可能会遇到器械扩张和不对称的不同组合。了解BAV形态对患者-器械关系的影响有助于改善器械选择、患者合格性和TAVR在BAV中的总体安全性。
The bicuspid aortic valve (BAV) is a common and heterogeneous congenital heart abnormality that is often complicated by aortic stenosis. Although initially developed for tricuspid aortic valves (TAV), transcatheter aortic valve replacement (TAVR) devices are increasingly applied to the treatment of BAV stenosis. It is known that patient-device relationship between TAVR and BAV are not equivalent to those observed in TAV but the nature of these differences are not well understood. We sought to better understand the patient-device relationships between TAVR devices and the two most common morphologies of BAV. We performed finite element simulation of TAVR deployment into three cases of idealized aortic anatomies (TAV, Sievers 0 BAV, Sievers 1 BAV), derived from patient-specific measurements. Valve leaflet von Mises stress at the aortic commissures differed by valve configuration over a ten-fold range (TAV: 0.55 MPa, Sievers 0: 6.64 MPa, and Sievers 1: 4.19 MPa). First principle stress on the aortic wall was greater in Sievers 1 (0.316 MPa) and Sievers 0 BAV (0.137 MPa) compared to TAV (0.056 MPa). TAVR placement in Sievers 1 BAV demonstrated significant device asymmetric alignment, with 1.09 mm of displacement between the center of the device measured at the annulus and at the leaflet free edge. This orifice displacement was marginal in TAV (0.33 mm) and even lower in Sievers 0 BAV (0.23 mm). BAV TAVR, depending on the subtype involved, may encounter disparate combinations of device under expansion and asymmetry compared to TAV deployment. Understanding the impacts of BAV morphology on patient-device relationships can help improve device selection, patient eligibility, and the overall safety of TAVR in BAV.
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影响因子：
3.7
作者：
Bavo AM;Rocatello G;Iannaccone F;Degroote J;Vierendeels J;Segers P
通讯作者：
Segers P
DOI：
10.1161/circinterventions.118.007107
发表时间：
2019-01-01
影响因子：
5.6
作者：
Tchetche, Didier;de Biase, Chiara;Van Mieghem, Nicolas M.
通讯作者：
Van Mieghem, Nicolas M.
影响因子：
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作者：
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通讯作者：
Bax, Jeroen J.
影响因子：
1.8
作者：
Luraghi, Giulia;Migliavacca, Francesco;Rodriguez Matas, Jose Felix
通讯作者：
Rodriguez Matas, Jose Felix
影响因子：
--
作者：
Khodaee, Farhan;Barakat, Mohammed;Azadani, Ali N.
通讯作者：
Azadani, Ali N.