Hemodynamics inside the neo- and native sinus after TAVR: effects of implant depth and cardiac output on flow field and coronary flow.
Hemodynamics inside the neo- and native sinus after TAVR: effects of implant depth and cardiac output on flow field and coronary flow.
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TAVR 后新窦和原生窦内的血流动力学：植入深度和心输出量对流场和冠状动脉流量的影响
DOI：
10.1111/aor.13789
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发表时间：
2021
影响因子：
2.4
通讯作者：
Schmitz C
中科院分区：
文献类型：
--
作者：
Pott D;Sedaghat A;Schmitz C
经导管主动脉瓣置换术（TAVR）已成为主动脉瓣疾病的广泛治疗方法。使用TAVR时，血流动力学可能发生变化，导致易于发生血栓形成风险的血流停滞区域。通过在患病的自体瓣膜内引入假体而形成的新窦可能会由于血流停滞区域而促使瓣叶血栓形成。本研究试图了解不同假体植入深度对新生和自体窦内流场以及冠状动脉灌注的影响。根据ISO 5840 - 1：2015标准，在产生生理条件的体外脉冲复制器内进行实验。采用粒子图像测速仪（PIV）获得了两个心输出量（CO）的流场。计算洗脱作为血流停滞的量度。两个主要结果是：较低的植入位置和较低的CO/频率导致更好的自体窦冲洗，但新窦冲洗恶化。相比之下，较高的植入位置导致较高的冠状动脉流量（对于较高的CO/频率）。对于较低的CO/频率，未观察到植入深度对冠状动脉血流的显著影响。总之，使用这种自膨式假体的较高植入位置与减少新窦血流淤滞相关。因此，天然窦的冲洗以及冠状动脉流量取决于心输出量。
Transcatheter aortic valve replacement (TAVR) has emerged as a widely used therapy for aortic valve diseases. With TAVR, flow hemodynamics may change leading to areas of flow stagnation prone to thrombosis risk. The neo‐sinus, created by introducing a prosthesis inside the diseased native valve, may prompt leaflet thrombosis due to areas of flow stasis. This study attempted to understand the effect of different prosthesis implant depths on the flow field within the neo‐ and native sinus and on the coronary perfusion. Experiments were performed inside an in vitro pulse duplicator producing physiological conditions according to ISO 5840‐1:2015 standard. Flow fields were obtained for two cardiac outputs (CO) using particle image velocimetry (PIV). Washout was calculated as a measure of flow stasis. The two main results are: a lower implant position and a lower CO/frequency led to better native sinus washout, but worsened neo‐sinus washout. In contrast, a higher implant position led to higher coronary flow (for higher CO/frequency). No significant effect of implant depth on coronary flow was observed for lower CO/frequency. In summary, a higher implant position using this self‐expanding prosthesis is associated with reduced neo‐sinus flow stasis. Hereby, washout of the native sinus, as well as coronary flow, are dependent on cardiac output.
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