On the Modeling of Patient-Specific Transcatheter Aortic Valve Replacement: A Fluid-Structure Interaction Approach
On the Modeling of Patient-Specific Transcatheter Aortic Valve Replacement: A Fluid-Structure Interaction Approach
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DOI：
10.1007/s13239-019-00427-0
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发表时间：
2019-09-01
影响因子：
1.8
通讯作者：
Rodriguez Matas, Jose Felix
中科院分区：
文献类型：
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作者：
Luraghi, Giulia;Migliavacca, Francesco;Rodriguez Matas, Jose Felix
目的经导管主动脉瓣置换术(TAVR)是治疗高危主动脉疾病的一种微创治疗方法。尽管它的使用越来越多，但许多影响因素仍有待了解，需要继续研究。能够同时再现瓣膜力学和血流动力学的最好的数值方法是流体-结构相互作用(FSI)模型。这项工作的目的是开发一种针对患者的FSI方法，能够对植入阶段以及心脏周期中的瓣膜工作条件进行建模。方法根据CT图像重建主动脉根部、自然瓣膜和钙化部位，根据文献资料提取支架和心包的CAD模型。从患者数据中提取的室压和主动脉压波形被用作边界条件。该方法被应用于两个真实的临床病例，在瓣膜旁渗漏(PVL)方面呈现出不同的结果，PVL是TAVR后的主要并发症。结果以返流量和有效返流口面积的相关值确定轻、中度PVL的临床预后。最后，将装置的最终释放形态和速度场与术后CT扫描和多普勒轨迹进行比较，显示出良好的定性和定量匹配。结论建立真实、准确的FSI患者特异性模型可作为植入前临床决策的依据。
Purpose Transcatheter aortic valve replacement (TAVR) is a minimally invasive treatment for high-risk patients with aortic diseases. Despite its increasing use, many influential factors are still to be understood and require continuous investigation. The best numerical approach capable of reproducing both the valves mechanics and the hemodynamics is the fluid-structure interaction (FSI) modeling. The aim of this work is the development of a patient-specific FSI methodology able to model the implantation phase as well as the valve working conditions during cardiac cycles. Methods The patient-specific domain, which included the aortic root, native valve and calcifications, was reconstructed from CT images, while the CAD model of the device, metallic frame and pericardium, was drawn from literature data. Ventricular and aortic pressure waveforms, derived from the patient's data, were used as boundary conditions. The proposed method was applied to two real clinical cases, which presented different outcomes in terms of paravalvular leakage (PVL), the main complication after TAVR. Results The results confirmed the clinical prognosis of mild and moderate PVL with coherent values of regurgitant volume and effective regurgitant orifice area. Moreover, the final release configuration of the device and the velocity field were compared with postoperative CT scans and Doppler traces showing a good qualitative and quantitative matching. Conclusion In conclusion, the development of realistic and accurate FSI patient-specific models can be used as a support for clinical decisions before the implantation.