A validated methodology for patient specific computational modeling of self-expandable transcatheter aortic valve implantation
A validated methodology for patient specific computational modeling of self-expandable transcatheter aortic valve implantation
复制标题
DOI：
10.1016/j.jbiomech.2016.06.024
复制
发表时间：
2016-09-06
影响因子：
2.4
通讯作者：
Vander Sloten, Jos
中科院分区：
文献类型：
--
作者：
Bosmans, Bart;Famaey, Nele;Vander Sloten, Jos
经导管主动脉瓣植入术后，植入物旁的血液泄漏是一种相对常见且限制生命的并发症。本研究的目的是开发和验证一个工作流程，以模拟介入前的植入。根据模拟结果，估计泄漏量，以评估严重并发症的风险。基于术前计算机断层扫描，创建了10例患者支架植入的有限元模型。所有10例患者在植入后还接受了随访计算机断层扫描。该扫描用于提取支架的变形几何形状和钙化位置，以确认模拟结果。模拟支架和术后支架之间的最大平均周长差异为2.9 +/- 2.1 mm，发生在器械底部。测试了模拟对软组织材料参数和主动脉根部壁厚的敏感性。当主动脉根部厚度增加一倍时，直径最大偏差为6%。当未观察到返流时，基于模拟支架与周围主动脉根部之间距离的泄漏分析结果符合良好。所开发的工具有可能通过在介入前为临床医生提供额外信息来减少泄漏的发生率和严重程度。模拟的几何形状和估计的泄漏可以帮助在治疗前决定最佳的植入物类型、尺寸和位置。(C)2016爱思唯尔有限公司版权所有
Leakage of blood alongside the implant is a relatively frequent and life-limiting complication after transcatheter aortic valve implantation. The aim of this study is to develop and validate a workflow to simulate the implantation prior to the intervention. Based on the simulation outcome, the amount of leakage is estimated in order to evaluate the risk of a severe complication. A finite element model of the stent implantation in 10 patients was created based on a pre-operative computed tomography scan. All 10 patients also received a follow-up computed tomography scan, after the implantation. This scan was used to extract the deformed geometry of the stent and the position of the calcifications for validation of the simulation results. The maximal average perimeter difference between the simulated stent and the post-operative stent is 2.9 +/- 2.1 mm, and occurs at the bottom of the device. The sensitivity of the simulation to the soft tissue material parameters and aortic root wall thickness was tested. The maximal diameter deviation of 6% occurred when the thickness of the aortic root was doubled. The result of the leakage analysis based on the distance between the simulated stent and the surrounding aortic root corresponded well when no regurgitation was observed. The developed tools have the potential to reduce the occurrence and severity of leakage by providing the clinician with additional information prior to the intervention. The simulated geometry and estimated leakage can help decide on the best implant type, size and position before treatment. (C) 2016 Elsevier Ltd. All rights reserved.