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Review
. 2022 Jun 3;6(2):100032.
doi: 10.1016/j.shj.2022.100032. eCollection 2022 Jun.

Biomechanics of Transcatheter Aortic Valve Replacement Complications and Computational Predictive Modeling

Fateme Esmailie  1 , Atefeh Razavi  1 , Breandan Yeats  1 , Sri Krishna Sivakumar  1 , Huang Chen  1 , Milad Samaee  1 , Imran A Shah  1 , Alessandro Veneziani  2 , Pradeep Yadav  3 , Vinod H Thourani  4 , Lakshmi Prasad Dasi  1
Affiliations
Review

Biomechanics of Transcatheter Aortic Valve Replacement Complications and Computational Predictive Modeling

Fateme Esmailie et al. Struct Heart. .

Abstract

Transcatheter aortic valve replacement (TAVR) is a rapidly growing field enabling replacement of diseased aortic valves without the need for open heart surgery. However, due to the nature of the procedure and nonremoval of the diseased tissue, there are rates of complications ranging from tissue rupture and coronary obstruction to paravalvular leak, valve thrombosis, and permanent pacemaker implantation. In recent years, computational modeling has shown a great deal of promise in its capabilities to understand the biomechanical implications of TAVR as well as help preoperatively predict risks inherent to device-patient-specific anatomy biomechanical interaction. This includes intricate replication of stent and leaflet designs and tested and validated simulated deployments with structural and fluid mechanical simulations. This review outlines current biomechanical understanding of device-related complications from TAVR and related predictive strategies using computational modeling. An outlook on future modeling strategies highlighting reduced order modeling which could significantly reduce the high time and cost that are required for computational prediction of TAVR outcomes is presented in this review paper. A summary of current commercial/in-development software is presented in the final section.

Keywords: Computational predictive models; Coronary obstruction; Leaflet thrombosis; Patient prosthesis mismatch; Permanent pacemaker implantation; Root rupture.

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Conflict of interest statement

Dr. Dasi and co-authors report patents filed on predictive computational modeling for planning structural heart procedures.

Figures

Figure 1
Figure 1
SAPIEN S3 transcatheter heart valve deployment in a patient who experienced aortic root rupture with detection of high stress in the region where the rupture occurred.
Figure 2
Figure 2
Conduction system location just below the membranous septum. Reprinted with permission from Massing GK, James TN. Anatomical configuration of the His bundle and bundle branches in the human heart. Circulation. 1976;53(4):609-621. (https://www.ahajournals.org/doi/10.1161/01.CIR.53.4.609; The American Heart Association.)
Figure 3
Figure 3
Results of the simulation to obtain DLC and sensitivity/specificity curves for model. Reprinted from Heitkemper et al.
Figure 4
Figure 4
Comparison of risk of CO from computational modeling (DLC/d) with CT-based risk assessment (VTC) in 17 cases of ViV TAVR. Abbreviations: CO, coronary obstruction; CT, computed tomography; TAVR, transcatheter aortic valve replacement; ViV, valve-in-valve; VTC, valve-to-coronary.
Figure 5
Figure 5
FEA simulated deployment of a balloon-expandable THV in a good agreement with the postoperation CT stent geometry (left). CFD hemodynamics analysis enabled PVL detection and quantification at a native commissure point due to incomplete sealing of the device. Reprinted by permission from Springer Nature, Current Cardiology Reports: Yeats, B.B., Yadav, P.K., Dasi, L.P. et al. Treatment of Bicuspid Aortic Valve Stenosis with TAVR: Filling Knowledge Gaps Towards Reducing Complications. Curr Cardiol Rep. 2022; 33–41, © 2022. Abbreviations: CFD, computational fluid dynamics; CT, computed tomography; FEA, finite element analysis; PVL, paravalvular leak; THV, transcatheter heart valve.
Figure 6
Figure 6
Comparison of the displacement field for the reduced order model (ROM) solution (a) and the finite element model (FEM) solution (b).
See this image and copyright information in PMC

References

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