Mild Paravalvular Leak May Pose an Increased Thrombogenic Risk in Transcatheter Aortic Valve Replacement (TAVR) Patients-Insights from Patient Specific In Vitro and In Silico Studies.
Mild Paravalvular Leak May Pose an Increased Thrombogenic Risk in Transcatheter Aortic Valve Replacement (TAVR) Patients-Insights from Patient Specific In Vitro and In Silico Studies.
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轻度脊椎泄漏可能在经导管主动脉瓣置换（TAVR）患者特定体外和硅研究中的患者诊断中构成增加的血栓形成风险。
DOI：
10.3390/bioengineering10020188
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发表时间：
2023-02-01
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影响因子：
--
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近年来，TAVR治疗主动脉瓣狭窄迅速扩展到更年轻、风险更低的患者。然而，持续的血栓事件，如中风和瓣膜血栓形成，使接受者面临严重的临床并发症，阻碍了TAVR的快速发展。我们提出了一种新的方法，用于建立通过该装置的普遍可接受的轻度瓣膜旁渗漏(PVL)水平与增加血栓形成风险之间的联系。它利用体外患者特定的TAVR 3D打印复制品来评估流体力学性能。高分辨率µCT扫描用于在计算机FSI模型中重建这些复制品，在该模型中，通过PVL通道研究多个血小板轨迹以量化血栓形成能力，表明这些轨迹高度依赖于PVL通道内患者特定的血流条件。这表明，在连续的心动周期中，血小板有可能多次进入PVL通道，从而增加血栓形成的风险。这不能用标准的血流动力学参数来可靠地近似。它强调了临床上常用的主观分级PVL的缺点，指出在其他被归类为轻度PVL的患者中，血栓形成风险增加。它重申需要更严格的临床评估来正确诊断TAVR患者的血栓形成风险。
In recent years, the treatment of aortic stenosis with TAVR has rapidly expanded to younger and lower-risk patients. However, persistent thrombotic events such as stroke and valve thrombosis expose recipients to severe clinical complications that hamper TAVR’s rapid advance. We presented a novel methodology for establishing a link between commonly acceptable mild paravalvular leak (PVL) levels through the device and increased thrombogenic risk. It utilizes in vitro patient-specific TAVR 3D-printed replicas evaluated for hydrodynamic performance. High-resolution µCT scans are used to reconstruct in silico FSI models of these replicas, in which multiple platelet trajectories are studied through the PVL channels to quantify thrombogenicity, showing that those are highly dependent on patient-specific flow conditions within the PVL channels. It demonstrates that platelets have the potential to enter the PVL channels multiple times over successive cardiac cycles, increasing the thrombogenic risk. This cannot be reliably approximated by standard hemodynamic parameters. It highlights the shortcomings of subjectively ranked PVL commonly used in clinical practice by indicating an increased thrombogenic risk in patient cases otherwise classified as mild PVL. It reiterates the need for more rigorous clinical evaluation for properly diagnosing thrombogenic risk in TAVR patients.
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