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Case Reports
. 2015 Jan;14(1):29-38.
doi: 10.1007/s10237-014-0583-7. Epub 2014 Apr 16.

Simulations of transcatheter aortic valve implantation: implications for aortic root rupture

Qian Wang  1 , Susheel Kodali, Charles Primiano, Wei Sun
Affiliations
Case Reports

Simulations of transcatheter aortic valve implantation: implications for aortic root rupture

Qian Wang et al. Biomech Model Mechanobiol. 2015 Jan.

Abstract

Aortic root rupture is one of the most severe complications of transcatheter aortic valve implantation (TAVI). The mechanism of this adverse event remains mostly unknown. The purpose of this study was to obtain a better understanding of the biomechanical interaction between the tissue and stent for patients with a high risk of aortic rupture. We simulated the stent deployment process of three TAVI patients with high aortic rupture risk using finite element method. The first case was a retrospective analysis of an aortic rupture case, while the other two cases were prospective studies, which ended with one canceled procedure and one successful TAVI. Simulation results were evaluated for the risk of aortic root rupture, as well as coronary artery occlusion, and paravalvular leak. For Case 1, the simulated aortic rupture location was the same as clinical observations. From the simulation results, it can be seen that the large calcified spot on the interior of the left coronary sinus between coronary ostium and the aortic annulus was pushed by the stent, causing the aortic rupture. For Case 2 and Case 3, predicated results from the simulations were presented to the clinicians at multidisciplinary pre-procedure meetings; and they were in agreement with clinician's observations and decisions. Our results indicated that the engineering analysis could provide additional information to help clinicians evaluate complicated, high-risk aortic rupture cases. Since a systematic study of a large patient cohort of aortic rupture is currently not available (due to the low occurrence rate) to clearly understand underlying rupture mechanisms, case-by-case engineering analysis is recommended for evaluating patient-specific aortic rupture risk.

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Figures

Figure 1
Figure 1
MSCT images of the three stenotic aortic valves in long-axis and short-axis views, and reconstructed aortic root models in Abaqus
Figure 2
Figure 2
The development of the aortic root model of Case 3: (a) initial image segmentation in Avizo, (b) reconstructed models of aortic leaflets and calcification. For illustration purposes, the yellow geometry in our finite element models represents the aortic root, the green geometry represents non-calcified aortic leaflets, and the red geometry represents calcification.
Figure 3
Figure 3
(a) Transcather aortic valve stent and (b) a realistic balloon used to simulate (c) fluid controlled balloon deployment.
Figure 4
Figure 4
(a) Pre- and (b) post-deployment geometries of the aortic root of Case 1. (c) Full and (d) local views of the deformed the aortic root and balloon deployment indicates annulus tearing under the left coronary ostium due to dislodgement of calcification into the vulnerable part of the aortic sinus.
Figure 5
Figure 5
Side (a) and top views (b) of the deformed native valve leaflets of Case 1 after the maximum stent deployment showed high stress at location of tearing. Stress (in kPa) contour plot was created for the aortic sinuses.
Figure 6
Figure 6
Post-deployment geometries and stress (in kPa) contour plots of the aortic roots of ([a] and [c]) Case 2; and ([b] and [d]) Case 3 were utilized to evaluate the potential of complications such as aortic root rupture, coronary artery occlusion, and paravalvular leak. Stress (in kPa) contour plots ([c] and [d]) were created for the aortic sinuses.
Figure 7
Figure 7
Top view of the deformed native valve leaflets of Case 3 after the maximum stent deployment showed a small paravalvular leak.
See this image and copyright information in PMC

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