Author + information
- Received December 12, 2013
- Revision received February 10, 2014
- Accepted March 12, 2014
- Published online May 1, 2014.
- Qian Wang, MS∗,
- Charles Primiano, MD†,
- Raymond McKay, MD†,
- Susheel Kodali, MD‡ and
- Wei Sun, PhD∗∗ ()
- ∗Tissue Mechanics Laboratory, Biomedical Engineering Department, Georgia Institute of Technology, Atlanta, Georgia
- †Cardiology Department, The Hartford Hospital, Hartford, Connecticut
- ‡Center for Interventional Vascular Therapy, Columbia University College of Physicians and Surgeons, New York, New York
- ↵∗Reprint requests and correspondence:
Dr. Wei Sun, Room 206, Technology Enterprise Park, Georgia Institute of Technology, 387 Technology Circle, Atlanta, Georgia 30313-2412.
Despite the increased global experience with transcatheter aortic valve replacement (TAVR), there remain 3 major adverse events. Aortic rupture (Fig. 1), coronary artery obstruction (Fig. 2), and paravalvular leakage (PVL) (Fig. 3) may occur with valve implantation. Oversizing or excessive radial expansion force with the TAVR stent may cause aortic rupture, whereas insufficient dilation may lead to PVL and device migration. During TAVR implantation, native leaflet material may produce occlusion of the coronary ostia. A reliable prediction of the biomechanical interaction between native tissue and device in TAVR is crucial for the success of this procedure.
In this study, an image-based engineering analysis (Fig. 4) and prediction of transcatheter aortic valve deployment was performed using computational models reconstructed from multislice computed tomography images obtained from patients undergoing pre-TAVR evaluation. Four patients with tricuspid aortic valve stenosis subsequently received 23-mm transcatheter aortic valves (Sapien, Edwards Lifesciences Corporation, Irvine, California) (Table 1). Finite element models of the patients included aortic root, aortic leaflets, calcification, mitral-aortic intervalvular fibrosa, anterior mitral leaflet, fibrous trigones, and left ventricle. Simulations of the balloon deployment of the Sapien valve were utilized to evaluate the potential for the aforementioned complications (Online Video 1). The models presented in this paper assumed an optimal height and angulation of the stent, which is not necessarily true in all cases and is dependent, among others, on the angle between the ventricle and the aorta.
The method presented herein could be utilized as a pre-procedural planning tool to virtually predict device performance for TAVR and improve clinical outcomes.
The authors thank Caitlin Martin, Thuy Pham, and Kewei Li for providing experimental data on the heart tissues; Rebecca Newman for finite element model reconstruction; and Dura Biotech for providing technical support.
For a supplemental video and legend, please see the online version of this article.
This work was supported in part by National Institutes of Health grant nos. 1R01HL104080 and 1R21HL108239, and American Heart Association pre-doctoral fellowship 13PRE14830002. Dr. Kodali has received consulting fees and honoraria grants from Edwards Lifesciences Corporation and Thubrikar Aortic Valve, Inc.; and has been a member of the scientific advisory board for Thubrikar Aortic Valve, Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 12, 2013.
- Revision received February 10, 2014.
- Accepted March 12, 2014.
- American College of Cardiology Foundation