Neosinus and Sinus Flow After Self-Expanding and Balloon-Expandable Transcatheter Aortic Valve Replacement
- PMID: 34838462
- DOI: 10.1016/j.jcin.2021.09.013
Neosinus and Sinus Flow After Self-Expanding and Balloon-Expandable Transcatheter Aortic Valve Replacement
Abstract
Objectives: The aim of this study was to evaluate flow dynamics in the aortic sinus and the neosinus (NS) after transcatheter heart valve (THV) implantation in valve-in-valve (ViV).
Background: Leaflet thrombosis may occur on THVs and affect performance and durability. Differences in flow dynamics may affect the risk for leaflet thrombosis.
Methods: Hemodynamic assessment following THV implantation in a surgical aortic valve was performed in a left heart simulator under pulsatile physiological conditions. Assessment was performed using a 23-mm polymeric surgical aortic valve (not diseased) and multiple THV platforms, including self-expanding devices (26-mm Evolut, 23-mm Allegra, small ACURATE neo) and a balloon-expandable device (23-mm SAPIEN 3). Particle image velocimetry was performed to assess flow in the sinus and NS. Sinus and NS washout, shear stress, and velocity were calculated.
Results: Sinus and NS washout was fastest and approximately 1 cardiac cycle for each with the Evolut, ACURATE neo, and Allegra compared with the SAPIEN 3, with washout in 2 and 3 cardiac cycles, respectively. The Allegra showed the largest shear stress distribution in the sinus, followed by the SAPIEN 3. In the NS, all 4 valves showed equal likelihoods of occurrence of shear stress <1 Pa, but the Allegra showed the highest likelihoods of occurrence for shear stress >1 Pa. The velocities in the sinus and NS were 0.05, 0.078, 0.080, and 0.075 m/s for Evolut, SAPIEN 3, ACURATE neo, and Allegra ViV, respectively.
Conclusions: Sinus and NS flow dynamics differ substantially among THVs after ViV. Self-expanding supra-annular valves seem to have faster washouts compared with an equivalent-size balloon-expandable THV.
Keywords: TAVR; leaflet thrombosis; neosinus; valve-in-valve; washout.
Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Conflict of interest statement
Funding Support and Author Disclosures Dr Hatoum has patent applications for predicting leaflet thrombosis modeling and computational predictive modeling of thrombosis in heart valves. Dr Sathananthan is a consultant to Edwards Lifesciences, Medtronic, and New Valve Technology. Drs Kutting and Marx are in the research and development department of New Valve Technology, the developer of the Allegra valve. Dr Ihdayhid is a consultant for Boston Scientific, Canon Medical, and Artrya. Dr Thourani is a consultant for Abbott Vascular, Boston Scientific, Edwards Lifesciences, CryoLife, Shockwave, and JenaValve; and has a patent application for computational predictive modeling of thrombosis in heart valves. Dr Dasi is the founder and stockholder of 2 startups DasiSimulations LLC and YoungHeartValve Inc; and has patent applications for novel polymeric valves, vortex generators, superhydrophobic/omniphobic surfaces, predicting leaflet thrombosis modeling, and computational predictive modeling of thrombosis in heart valves. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
Comment in
-
Flow in the Aortic Sinus After Valve-in-Valve TAVR: Disruption of God's Creation?JACC Cardiovasc Interv. 2021 Dec 27;14(24):2667-2669. doi: 10.1016/j.jcin.2021.10.016. Epub 2021 Nov 24. JACC Cardiovasc Interv. 2021. PMID: 34838463 No abstract available.
MeSH terms
LinkOut - more resources
Full Text Sources
Miscellaneous
