Computational Analysis of Self-Expanding and Balloon-Expandable Transcatheter Heart Valves
Computational Analysis of Self-Expanding and Balloon-Expandable Transcatheter Heart Valves
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DOI：
10.3390/biomechanics1010004
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发表时间：
2021-03-01
期刊：
影响因子：
--
通讯作者：
Gandolfo, Caterina
中科院分区：
文献类型：
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作者：
Pasta, Salvatore;Gandolfo, Caterina
双叶主动脉瓣(BAV)患者通常被排除在经导管主动脉瓣植入术(TAVI)之外，因为这种瓣膜解剖结构可能导致椭圆形扩张。本研究对二尖瓣重度狭窄患者应用自膨胀式和球囊扩张式经导管心脏瓣膜(THV)的TAVI进行了数值研究。模拟框架包括从医学成像分析中提取的特定于患者的主动脉根部解剖、钙化和BAV传单，以及THV的逼真卷曲和展开。组织应力分析突出了主动脉内腔和THV支架之间接触区域的局部最大值。基于光滑粒子流体动力学(SPH)技术的流动分析显示了瓣膜旁渗漏(PVL)的危险区域。这些发现提供了对BAV中TAVI的见解，从而代表着进一步利用硅胶技术进行TAVI的虚拟规划，旨在不仅提高植入的效率，而且还探索边界解剖，如BAVs中的TAVI。
Bicuspid aortic valve (BAV) patients are usually excluded from transcatheter aortic valve implantation (TAVI) as this valve anatomy likely leads to oval expansion. This study presents a numerical study of TAVI using both self-expanding and balloon expandable transcatheter heart valve (THV) in bicuspid patients with severe stenosis. The simulation framework included a patient-specific anatomy of the aortic root, calcifications and BAV leaflets extracted from medical imaging analysis as well as a realistic crimping and deployment of the THV. Tissue stress analysis highlighted local maxima in the contact area between the inner aortic lumen and the THV stent frame. Flow analysis based on the smoothed particle hydrodynamics (SPH) technique displayed the area at risk of paravalvular leakage (PVL). These findings provide insights on the TAVI in BAV and thus represents a further step towards the use of in-silico for the virtual planning of TAVI, aiming at improving not only the efficacy of the implantation but also the exploration of borderline anatomy as the case of TAVI in BAVs.