A computational framework for post-TAVR cardiac conduction abnormality (CCA) risk assessment in patient-specific anatomy.
A computational framework for post-TAVR cardiac conduction abnormality (CCA) risk assessment in patient-specific anatomy.
复制标题
TAVR术后心脏传导异常(CCA)患者特定解剖风险评估的计算框架。
DOI：
10.1111/aor.14189
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发表时间：
2022-07
影响因子：
2.4
通讯作者：
中科院分区：
文献类型：
--
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心脏传导异常（CCA）——与经导管主动脉瓣置换术（TAVR）相关的主要持续性并发症之一，可能导致永久起搏器植入。装置框架对位于主动脉环和希氏束之间的膜间隔 (MS) 施加的局部应力可能会干扰心脏传导并导致由此产生的 CCA。我们假设 MS 区域的面积加权平均最大主对数应变 (AMPLS) 可以预测 TAVR 后发生 CCA 的风险。对两名患者（球囊扩张 TAVR 接受者）进行了严格的基于有限元的建模分析，以评估 TAVR 后 CCA 风险。手术后，其中一名患者需要植入永久性起搏器 (PPM)，而另一名患者则不需要（对照病例）。对患者特定的主动脉根进行建模，从 CT 图像中识别 MS，并模拟 TAVR 部署。 MS 区域的机械因素，如对数应变、接触力、接触压力、接触压力指数 (CPI) 及其在 TAVR 部署过程中的时间历程；并分析了 MS 长度、植入深度等解剖因素。与对照患者相比，PPM 患者 MS 区域的最大 AMPLS（分别为 0.47 和 0.37）、接触力（分别为 0.92 N 和 0.72 N）和 CPI（分别为 3.99 和 2.86）显着升高。 TAVR 设备在部署过程中产生的应力升高似乎与 CCA 风险相关，MS 区域的 AMPLS 成为强有力的预测因子，可用于术前规划，以最大限度地降低 CCA 风险。
Cardiac conduction abnormality (CCA)- one of the major persistent complications associated with transcatheter aortic valve replacement (TAVR) may lead to permanent pacemaker implantation. Localized stresses exerted by the device frame on the membranous septum (MS) which lies between the aortic annulus and the bundle of His, may disturb the cardiac conduction and cause the resultant CCA. We hypothesize that the area-weighted average maximum principal logarithmic strain (AMPLS) in the MS region can predict the risk of CCA following TAVR. Rigorous finite element-based modeling analysis was conducted in two patients (Balloon expandable TAVR recipients) to assess post-TAVR CCA risk. Following the procedure one of the patients required permanent pacemaker (PPM) implantation while the other did not (control case). Patient-specific aortic root was modeled, MS was identified from the CT image, and the TAVR deployment was simulated. Mechanical factors in the MS region such as logarithmic strain, contact force, contact pressure, contact pressure index (CPI) and their time history during the TAVR deployment; and anatomical factors such as MS length, implantation depth, were analyzed. Maximum AMPLS (0.47 and 0.37, respectively), contact force (0.92 N and 0.72 N, respectively), and CPI (3.99 and 2.86, respectively) in the MS region were significantly elevated in the PPM patient as compared to control patient. Elevated stresses generated by TAVR devices during deployment appear to correlate with CCA risk, with AMPLS in the MS region emerging as a strong predictor that could be used for preprocedural planning in order to minimize CCA risk.
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