1
|
Qi Y, Zhang X, Shen Z, Liang Y, Chen S, Pan W, Zhou D, Ge J. Force Analysis Using Self-Expandable Valve Fluoroscopic Imaging: a way Through Artificial Intelligence. J Cardiovasc Transl Res 2024; 17:1328-1337. [PMID: 39090482 DOI: 10.1007/s12265-024-10550-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2024] [Accepted: 07/16/2024] [Indexed: 08/04/2024]
Abstract
This study aimed to develop a force analysis model correlating fluoroscopic images of self-expandable valves with stress distribution. For this purpose, a nonmetallic measuring device designed to apply diverse forces at specific positions on a valve stent while simultaneously measuring force magnitude was manufactured, obtaining 465 sets of fluorescent films under different force conditions, resulting in 5580 images and their corresponding force tables. Using the XrayGLM, a mechanical analysis model based on valve fluorescence images was trained. The accuracy of the image force analysis using this model was approximately 70% (50-88.3%), with a relative accuracy of 93.3% (75-100%). This confirms that fluoroscopic images of transcatheter aortic valve replacement (TAVR) valve stents contain a wealth of mechanical information, and machine learning can be used to train models to recognize the relationship between stent images and force distribution, enhancing the understanding of TAVR complications.
Collapse
Affiliation(s)
- Yiming Qi
- Department of Cardiology, Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai , 180 Fenglin Road, Shanghai, China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, China
| | - Xiaochun Zhang
- Department of Cardiology, Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai , 180 Fenglin Road, Shanghai, China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, China
| | - Zhiyun Shen
- Department of Nursing, Zhongshan Hospital, Fudan University, 180 Fenglin Road, Shanghai, China
| | - Yixiu Liang
- Department of Cardiology, Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai , 180 Fenglin Road, Shanghai, China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai , 180 Fenglin Road, Shanghai, China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai , 180 Fenglin Road, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, China.
| | - Daxin Zhou
- Department of Cardiology, Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai , 180 Fenglin Road, Shanghai, China.
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Institute of Cardiovascular Diseases, Zhongshan Hospital, Fudan University, Shanghai , 180 Fenglin Road, Shanghai, China
- National Clinical Research Center for Interventional Medicine, 180 Fenglin Road, Shanghai, China
| |
Collapse
|
2
|
Pan XG, Corpuz AM, Rajanna MR, Johnson EL. Parameterization, algorithmic modeling, and fluid-structure interaction analysis for generative design of transcatheter aortic valves. ENGINEERING WITH COMPUTERS 2024; 40:3405-3427. [PMID: 39678645 PMCID: PMC11639685 DOI: 10.1007/s00366-024-01973-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Accepted: 03/19/2024] [Indexed: 12/17/2024]
Abstract
Heart valves play a critical role in maintaining proper cardiovascular function in the human heart; however, valve diseases can lead to improper valvular function and reduced cardiovascular performance. Depending on the extent and severity of the valvular disease, replacement operations are often required to ensure that the heart continues to operate properly in the cardiac system. Transcatheter aortic valve replacement (TAVR) procedures have recently emerged as a promising alternative to surgical replacement approaches because the percutaneous methods used in these implant operations are significantly less invasive than open heart surgery. Despite the advantages of transcatheter devices, the precise deployment, proper valve sizing, and stable anchoring required to securely place these valves in the aorta remain challenging even in successful TAVR procedures. This work proposes a parametric modeling approach for transcatheter heart valves (THVs) that enables flexible valvular development and sizing to effectively generate existing and novel valve designs. This study showcases two THV configurations that are analyzed using an immersogeometric fluid-structure interaction (IMGA FSI) framework to demonstrate the influence of geometric changes on THV performance. The proposed modeling framework illustrates the impact of these features on THV behavior and indicates the effectiveness of parametric modeling approaches for enhancing THV performance and efficacy in the future.
Collapse
Affiliation(s)
- Xianyu George Pan
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN USA
| | - Ashton M. Corpuz
- Department of Mechanical Engineering, Iowa State University, Ames, IA USA
| | | | - Emily L. Johnson
- Department of Aerospace and Mechanical Engineering, University of Notre Dame, Notre Dame, IN USA
| |
Collapse
|
3
|
Shah I, Samaee M, Razavi A, Esmailie F, Ballarin F, Dasi LP, Veneziani A. Reduced Order Modeling for Real-Time Stent Deformation Simulations of Transcatheter Aortic Valve Prostheses. Ann Biomed Eng 2024; 52:208-225. [PMID: 37962675 DOI: 10.1007/s10439-023-03360-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2023] [Accepted: 09/01/2023] [Indexed: 11/15/2023]
Abstract
Computational modeling can be a critical tool to predict deployment behavior for transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis. However, due to the mechanical complexity of the aortic valve and the multiphysics nature of the problem, described by partial differential equations (PDEs), traditional finite element (FE) modeling of TAVR deployment is computationally expensive. In this preliminary study, a PDEs-based reduced order modeling (ROM) framework is introduced for rapidly simulating structural deformation of the Medtronic Evolut R valve stent frame. Using fifteen probing points from an Evolut model with parametrized loads enforced, 105 FE simulations were performed in the so-called offline phase, creating a snapshot library. The library was used in the online phase of the ROM for a new set of applied loads via the proper orthogonal decomposition-Galerkin (POD-Galerkin) approach. Simulations of small radial deformations of the Evolut stent frame were performed and compared to full order model (FOM) solutions. Linear elastic and hyperelastic constitutive models in steady and unsteady regimes were implemented within the ROM. Since the original POD-Galerkin method is formulated for linear problems, specific methods for the nonlinear terms in the hyperelastic case were employed, namely, the Discrete Empirical Interpolation Method. The ROM solutions were in strong agreement with the FOM in all numerical experiments, with a speed-up of at least 92% in CPU Time. This framework serves as a first step toward real-time predictive models for TAVR deployment simulations.
Collapse
Affiliation(s)
- Imran Shah
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, 387 Technology Circle, Atlanta, GA, 30313, USA
- Department of Mathematics, Emory University, 400 Dowman Drive, Atlanta, GA, 30322, USA
| | - Milad Samaee
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, 387 Technology Circle, Atlanta, GA, 30313, USA
| | - Atefeh Razavi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, 387 Technology Circle, Atlanta, GA, 30313, USA
| | - Fateme Esmailie
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, 387 Technology Circle, Atlanta, GA, 30313, USA
| | - Francesco Ballarin
- Department of Mathematics and Physics, Università Cattolica del Sacro Cuore, 48 Via Della Garzetta, 25133, Brescia, Italy
| | - Lakshmi P Dasi
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, 387 Technology Circle, Atlanta, GA, 30313, USA.
| | - Alessandro Veneziani
- Department of Mathematics, Emory University, 400 Dowman Drive, Atlanta, GA, 30322, USA.
- Department of Computer Science, Emory University, 400 Dowman Drive, Atlanta, GA, 30322, USA.
| |
Collapse
|
4
|
Qi Y, Ding Y, Pan W, Zhang X, Lin X, Chen S, Zhang L, Zhou D, Ge J. Mean compression ratio of a self-expandable valve is associated with the need for pacemaker implantation after transcatheter aortic valve replacement. Eur J Med Res 2024; 29:85. [PMID: 38287454 PMCID: PMC10826074 DOI: 10.1186/s40001-023-01070-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Accepted: 02/15/2023] [Indexed: 01/31/2024] Open
Abstract
BACKGROUND The risk and timing of permanent pacemaker implantation (PPMI) after transcatheter aortic valve replacement (TAVR) is still hard to predict. We aimed to analyze the relationship between the compression ratio of a self-expandable valve (SEV) and the need for PPMI after TAVR. METHODS A total of 106 patients who were implanted with the VitaFlow transcatheter aortic valve system and for whom complete imaging information was available were included in this retrospective cohort study. Eight lines perpendicular to the long axis of the SEV were drawn (the top and bottom of the SEV and the intersection of each row of wires) for measurement purposes. The compression ratio was calculated as 1 - (in vivo meridian/in vitro meridian) and compared between patients undergoing and those not undergoing PPMI after adjusting for implantation depth. Multivariable logistic regression and Cox proportional hazards models were used to assess factors associated with the risk and timing of the need for PPMI. RESULTS Fifteen (14.2%) patients underwent PPMI after TAVR. Patients with a higher mean compression ratio (20%, odds ratio [OR] = 214.82; p < 0.001) and prior right bundle branch block (OR = 51.77; p = 0.015) had a higher risk of the need for PPMI after TAVR. These two factors were also associated with the timing of PPMI, according to the Cox proportional hazards model. CONCLUSIONS The compression ratio of the SEV was positively associated with the risk of PPMI after TAVR, and the association was most significant in the annular and supravalvular planes. The compression ratio may also affect the time to PPMI.
Collapse
Affiliation(s)
- Yiming Qi
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Yuefan Ding
- School of Data Science, Fudan University, Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Xiaochun Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Xiaolei Lin
- School of Data Science, Fudan University, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Lei Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, National Clinical Research Center for Interventional Medicine, Fudan University, Shanghai, China
| |
Collapse
|
5
|
Qi Y, Lin X, Pan W, Zhang X, Ding Y, Chen S, Zhang L, Zhou D, Ge J. A prediction model for permanent pacemaker implantation after transcatheter aortic valve replacement. Eur J Med Res 2023; 28:262. [PMID: 37516891 PMCID: PMC10387194 DOI: 10.1186/s40001-023-01237-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Accepted: 07/18/2023] [Indexed: 07/31/2023] Open
Abstract
BACKGROUND This study aims to develop a post-procedural risk prediction model for permanent pacemaker implantation (PPMI) in patients treated with transcatheter aortic valve replacement (TAVR). METHODS 336 patients undergoing TAVR at a single institution were included for model derivation. For primary analysis, multivariate logistic regression model was used to evaluate predictors and a risk score system was devised based on the prediction model. For secondary analysis, a Cox proportion hazard model was performed to assess characteristics associated with the time from TAVR to PPMI. The model was validated internally via bootstrap and externally using an independent cohort. RESULTS 48 (14.3%) patients in the derivation set had PPMI after TAVR. Prior right bundle branch block (RBBB, OR: 10.46; p < 0.001), pre-procedural aortic valve area (AVA, OR: 1.41; p = 0.004) and post- to pre-procedural AVA ratio (OR: 1.72; p = 0.043) were identified as independent predictors for PPMI. AUC was 0.7 and 0.71 in the derivation and external validation set. Prior RBBB (HR: 5.07; p < 0.001), pre-procedural AVA (HR: 1.33; p = 0.001), post-procedural AVA to prosthetic nominal area ratio (HR: 0.02; p = 0.039) and post- to pre-procedural troponin-T difference (HR: 1.72; p = 0.017) are independently associated with time to PPMI. CONCLUSIONS The post-procedural prediction model achieved high discriminative power and accuracy for PPMI. The risk score system was constructed and validated, providing an accessible tool in clinical setting regarding the Chinese population.
Collapse
Affiliation(s)
- Yiming Qi
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiaolei Lin
- School of Data Science, Fudan University, Shanghai, China
| | - Wenzhi Pan
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Xiaochun Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Yuefan Ding
- School of Data Science, Fudan University, Shanghai, China
| | - Shasha Chen
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Lei Zhang
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| | - Daxin Zhou
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China.
- National Clinical Research Center for Interventional Medicine, Shanghai, China.
| | - Junbo Ge
- Department of Cardiology, Zhongshan Hospital, Shanghai Institute of Cardiovascular Diseases, Fudan University, 180 Fenglin Road, Shanghai, 200032, China
- National Clinical Research Center for Interventional Medicine, Shanghai, China
| |
Collapse
|
6
|
Huang X, Zhang G, Zhou X, Yang X. A review of numerical simulation in transcatheter aortic valve replacement decision optimization. Clin Biomech (Bristol, Avon) 2023; 106:106003. [PMID: 37245279 DOI: 10.1016/j.clinbiomech.2023.106003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Revised: 05/08/2023] [Accepted: 05/15/2023] [Indexed: 05/30/2023]
Abstract
BACKGROUND Recent trials indicated a further expansion of clinical indication of transcatheter aortic valve replacement to younger and low-risk patients. Factors related to longer-term complications are becoming more important for use in these patients. Accumulating evidence indicates that numerical simulation plays a significant role in improving the outcome of transcatheter aortic valve replacement. Understanding mechanical features' magnitude, pattern, and duration is a topic of ongoing relevance. METHODS We searched the PubMed database using keywords such as "transcatheter aortic valve replacement" and "numerical simulation" and reviewed and summarized relevant literature. FINDINGS This review integrated recently published evidence into three subtopics: 1) prediction of transcatheter aortic valve replacement outcomes through numerical simulation, 2) implications for surgeons, and 3) trends in transcatheter aortic valve replacement numerical simulation. INTERPRETATIONS Our study offers a comprehensive overview of the utilization of numerical simulation in the context of transcatheter aortic valve replacement, and highlights the advantages, potential challenges from a clinical standpoint. The convergence of medicine and engineering plays a pivotal role in enhancing the outcomes of transcatheter aortic valve replacement. Numerical simulation has provided evidence of potential utility for tailored treatments.
Collapse
Affiliation(s)
- Xuan Huang
- Department of Cardiovascular Surgery, West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China
| | - Guangming Zhang
- Center for Computational Systems Medicine, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Xiaobo Zhou
- Center for Computational Systems Medicine, School of Biomedical Informatics, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA; School of Dentistry, The University of Texas Health Science Center at Houston, Houston, TX 77030, USA
| | - Xiaoyan Yang
- Department of Cardiovascular Surgery, West China Biomedical Big Data Center, West China Hospital/West China School of Medicine, Sichuan University, Chengdu, Sichuan, China; Med-X Center for Informatics, Sichuan University, Chengdu, Sichuan, China.
| |
Collapse
|
7
|
Carbonaro D, Zambon S, Corti A, Gallo D, Morbiducci U, Audenino AL, Chiastra C. Impact of nickel-titanium super-elastic material properties on the mechanical performance of self-expandable transcatheter aortic valves. J Mech Behav Biomed Mater 2023; 138:105623. [PMID: 36535095 DOI: 10.1016/j.jmbbm.2022.105623] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2022] [Revised: 12/06/2022] [Accepted: 12/11/2022] [Indexed: 12/14/2022]
Abstract
Self-expandable transcatheter aortic valves (TAVs) elastically resume their initial shape when implanted without the need for balloon inflation by virtue of the nickel-titanium (NiTi) frame super-elastic properties. Experimental findings suggest that NiTi mechanical properties can vary markedly because of a strong dependence on the chemical composition and processing operations. In this context, this study presents a computational framework to investigate the impact of the NiTi super-elastic material properties on the TAV mechanical performance. Finite element (FE) analyses of TAV implantation were performed considering two different TAV frames and three idealized aortic root anatomies, evaluating the device mechanical response in terms of pullout force magnitude exerted by the TAV frame and peak maximum principal stress within the aortic root. The widely adopted NiTi constitute model by Auricchio and Taylor (1997) was used. A multi-parametric sensitivity analysis and a multi-objective optimization of the TAV mechanical performance were conducted in relation to the parameters of the NiTi constitutive model. The results highlighted that: five NiTi material model parameters (EA, σtLS, σtUS, σtUE and σcLS) are significantly correlated with the FE outputs; the TAV frame geometry and aortic root anatomy have a marginal effect on the level of influence of each NiTi material parameter; NiTi alloy candidates with pareto-optimal characteristics in terms of TAV mechanical performance can be successfully identified. In conclusion, the proposed computational framework supports the TAV design phase, providing information on the relationship between the super-elastic behavior of the supplied NiTi alloys and the device mechanical response.
Collapse
Affiliation(s)
- Dario Carbonaro
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Sara Zambon
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Anna Corti
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Politecnico di Milano, Milan, Italy
| | - Diego Gallo
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Umberto Morbiducci
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Alberto L Audenino
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy
| | - Claudio Chiastra
- PoliTo(BIO)Med Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Turin, Italy.
| |
Collapse
|
8
|
Elsisy M, Tillman B, Chau L, Go C, Cho SK, Chun Y. In vitro and In vivo assessment of a novel organ perfusion stent for successful flow separation in donation after cardiac death. J Biomater Appl 2022; 37:389-401. [PMID: 35466766 PMCID: PMC9578539 DOI: 10.1177/08853282221093753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Shortage of healthy donors' organs has appeared as one of the main challenges for organ transplantation. This study focuses on the novel endovascular device development to increase the number of available organs from cardiac death donors. The primary objective of this study is the design validation of a newly developed stent graft for the abdominal organ perfusion with cardiac blood flow isolation. In this paper, the effectiveness of the device design has been validated via the assessment of the device performance both in vitro and in vivo. The radial force of stent structure was first numerically analyzed using finite element method, then was quantified experimentally. The blood perfusion parameters were investigated to demonstrate their effect on the blood delivered to the abdominal organs, maintaining the organs healthy for donation. In vitro flow leakage was measured using a 3-D printing-based silicone aortic model to evaluate the isolation between cardiac flow and perfusion flow with minimum values. Following the design validation process, a functional prototype stent graft has been successfully fabricated using optimized laser welding conditions and subsequent joining processes. In vivo porcine study results have demonstrated smooth delivery and successful placement of the device showing complete cardiac flow separation isolating abdominal regions only with the oxygenated blood flow.
Collapse
Affiliation(s)
- Moataz Elsisy
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Bryan Tillman
- The Ohio State University Medical Center, Columbus, OH, USA
| | - Lynn Chau
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Catherine Go
- University of Pittsburgh Medical Center, Pittsburgh, PA, USA
| | - Sung Kwon Cho
- University of Pittsburgh Swanson School of Engineering, Pittsburgh, PA, USA
| | - Youngjae Chun
- Department of Industrial Engineering, University of Pittsburgh, Pittsburgh, PA, USA
| |
Collapse
|
9
|
Barati S, Fatouraee N, Nabaei M, Petrini L, Migliavacca F, Luraghi G, Matas JFR. Patient-specific multi-scale design optimization of transcatheter aortic valve stents. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 221:106912. [PMID: 35640391 DOI: 10.1016/j.cmpb.2022.106912] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 05/09/2022] [Accepted: 05/24/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND AND OBJECTIVE Transcatheter aortic valve implantation (TAVI) has become the standard treatment for a wide range of patients with aortic stenosis. Although some of the TAVI post-operative complications are addressed in newer designs, other complications and lack of long-term and durability data on the performance of these prostheses are limiting this procedure from becoming the standard for heart valve replacements. The design optimization of these devices with the finite element and optimization techniques can help increase their performance quality and reduce the risk of malfunctioning. Most performance metrics of these prostheses are morphology-dependent, and the design and the selection of the device before implantation should be planned for each individual patient. METHODS In this study, a patient-specific aortic root geometry was utilized for the crimping and implantation simulation of 50 stent samples. The results of simulations were then evaluated and used for developing regression models. The strut width and thickness, the number of cells and patterns, the size of stent cells, and the diameter profile of the stent were optimized with two sets of optimization processes. The objective functions included the maximum crimping strain, radial strength, anchorage area, and the eccentricity of the stent. RESULTS The optimization process was successful in finding optimal models with up to 40% decrease in the maximum crimping strain, 261% increase in the radial strength, 67% reduction in the eccentricity, and about an eightfold increase in the anchorage area compared to the reference device. CONCLUSIONS The stents with larger distal diameters perform better in the selected objective functions. They provide better anchorage in the aortic root resulting in a smaller gap between the device and the surrounding tissue and smaller contact pressure. This framework can be used in designing patient-specific stents and improving the performance of these devices and the outcome of the implantation process.
Collapse
Affiliation(s)
- Sara Barati
- Biological Fluid Dynamics Research Laboratory, Biomedical Engineering Department, Amirkabir University of Technology, 350 Hafez Ave, Tehran, Iran
| | - Nasser Fatouraee
- Biological Fluid Dynamics Research Laboratory, Biomedical Engineering Department, Amirkabir University of Technology, 350 Hafez Ave, Tehran, Iran.
| | - Malikeh Nabaei
- Biological Fluid Dynamics Research Laboratory, Biomedical Engineering Department, Amirkabir University of Technology, 350 Hafez Ave, Tehran, Iran
| | - Lorenza Petrini
- Department of Civil and Environmental Engineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy
| | - Giulia Luraghi
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy.
| | - Josè Felix Rodriguez Matas
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials, and Chemical Engineering "Giulio Natta", Politecnico di Milano, Piazza Leonardo da Vinci 32, Milan 20133, Italy.
| |
Collapse
|
10
|
Reza S, Bianchi M, Kovarovic B, Anam S, Slepian MJ, Hamdan A, Haj-Ali R, Bluestein D. A computational framework for post-TAVR cardiac conduction abnormality (CCA) risk assessment in patient-specific anatomy. Artif Organs 2022; 46:1305-1317. [PMID: 35083748 DOI: 10.1111/aor.14189] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Revised: 12/14/2021] [Accepted: 01/18/2022] [Indexed: 11/27/2022]
Abstract
BACKGROUND 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. METHODS 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. RESULTS 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. CONCLUSION 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.
Collapse
Affiliation(s)
- Symon Reza
- Department of Biomedical Engineering, Stony Brook University, NY, USA
| | - Matteo Bianchi
- Department of Biomedical Engineering, Stony Brook University, NY, USA
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, NY, USA
| | - Salwa Anam
- Department of Biomedical Engineering, Stony Brook University, NY, USA
| | - Marvin J Slepian
- Department of Biomedical Engineering, University of Arizona, Tucson, AZ, USA
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Faculty of Medicine, Tel-Aviv University, Tel Aviv, Israel
| | - Rami Haj-Ali
- The Fleischman Faculty of Engineering, School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Ramat Aviv, Israel
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, NY, USA
| |
Collapse
|
11
|
Force distribution within the frame of self-expanding transcatheter aortic valve: Insights from in-vivo finite element analysis. J Biomech 2021; 128:110804. [PMID: 34656011 DOI: 10.1016/j.jbiomech.2021.110804] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Revised: 10/05/2021] [Accepted: 10/06/2021] [Indexed: 02/05/2023]
Abstract
We sought to assess the amount and distribution of force on the valve frame after transcatheter aortic valve replacement (TAVR) via patient-specific computer simulation. Patients successfully treated with the self-expanding Venus A-Valve and multislice computed tomography (MSCT) pre- and post-TAVR were retrospectively included. Patient-specific finite element models of the aortic root and prosthesis were constructed. The force (in Newton) on the valve frame was derived at every 3 mm from the inflow and at every 22.5° on each level. Twenty patients of whom 10 had bicuspid aortic valve (BAV) were analyzed. The total force on the frame was 74.9 N in median (interquartile range 24.0). The maximal force was observed at level 5 that corresponds with the nadir of the bioprosthetic leaflets and was 9.9 (7.1) N in all patients, 10.3 (6.6) N in BAV and 9.7 (9.2) N for patients with tricuspid aortic valve (TAV). The level of maximal force located higher from the native annulus in BAV and TAV patients (8.8 [4.8] vs. 1.8 [7.4] mm). The area of the valve frame at the level of maximal force decreased from 437.4 (239.7) mm2 at the annulus to 377.6 (114.3) mm2 in BAV, but increased from 397.5 (114.3) mm2 at the annulus to 406.7 (108.9) mm2 in TAV. The maximum force on the bioprosthetic valve frame is located at the plane of the nadir of the bioprosthetic leaflets. It remains to be elucidated whether this may be associated with bioprosthetic frame and leaflet integrity and/or function.
Collapse
|
12
|
Bui HT, Khair N, Yeats B, Gooden S, James SP, Dasi LP. Transcatheter Heart Valves: A Biomaterials Perspective. Adv Healthc Mater 2021; 10:e2100115. [PMID: 34038627 DOI: 10.1002/adhm.202100115] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 04/23/2021] [Indexed: 11/11/2022]
Abstract
Heart valve disease is prevalent throughout the world, and the number of heart valve replacements is expected to increase rapidly in the coming years. Transcatheter heart valve replacement (THVR) provides a safe and minimally invasive means for heart valve replacement in high-risk patients. The latest clinical data demonstrates that THVR is a practical solution for low-risk patients. Despite these promising results, there is no long-term (>20 years) durability data on transcatheter heart valves (THVs), raising concerns about material degeneration and long-term performance. This review presents a detailed account of the materials development for THVRs. It provides a brief overview of THVR, the native valve properties, the criteria for an ideal THV, and how these devices are tested. A comprehensive review of materials and their applications in THVR, including how these materials are fabricated, prepared, and assembled into THVs is presented, followed by a discussion of current and future THVR biomaterial trends. The field of THVR is proliferating, and this review serves as a guide for understanding the development of THVs from a materials science and engineering perspective.
Collapse
Affiliation(s)
- Hieu T. Bui
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Nipa Khair
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Breandan Yeats
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Shelley Gooden
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| | - Susan P. James
- School of Advanced Materials Discovery Colorado State University 700 Meridian Ave Fort Collins CO 80523 USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering Georgia Institute of Technology 387 Technology Cir NW Atlanta GA 30313 USA
| |
Collapse
|
13
|
Abstract
Heart valve diseases are common disorders with five million annual diagnoses being made in the United States alone. All heart valve disorders alter cardiac hemodynamic performance; therefore, treatments aim to restore normal flow. This paper reviews the state-of-the-art clinical and engineering advancements in heart valve treatments with a focus on hemodynamics. We review engineering studies and clinical literature on the experience with devices for aortic valve treatment, as well as the latest advancements in mitral valve treatments and the pulmonic and tricuspid valves on the right side of the heart. Upcoming innovations will potentially revolutionize treatment of heart valve disorders. These advancements, and more gradual enhancements in the procedural techniques and imaging modalities, could improve the quality of life of patients suffering from valvular disease who currently cannot be treated.
Collapse
Affiliation(s)
- Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv Israel
- To whom correspondence should be addressed. E-mail:
| | - Shmuel Einav
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| |
Collapse
|
14
|
Elsisy M, Tillman BW, Go C, Kuhn J, Cho SK, Clark WW, Park J, Chun Y. Comprehensive assessment of mechanical behavior of an extremely long stent graft to control hemorrhage in torso. J Biomed Mater Res B Appl Biomater 2020; 108:2192-2203. [PMID: 31943806 DOI: 10.1002/jbm.b.34557] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2019] [Revised: 12/16/2019] [Accepted: 01/06/2020] [Indexed: 11/07/2022]
Abstract
Traumatic vascular injuries, resulting from either civilian accidents or wounded soldiers, require new endovascular devices (i.e., stent graft) to rapidly control the excessive internal hemorrhage in torso region. Current stent designs are limited by their permanent nature, which is note well suited for emergent placement. A retrievable stent graft could regulate the internal bleeding temporarily, as fast as possible with the most feasible performance, until the patients arrive the hospital to receive the proper treatment. The novel endovascular device of this study is designed according to the anatomy of a porcine model with plans to transition to a human model in the future. The stent graft is manufactured using a substantially long nitinol backbone and covered selectively based on anatomic measurements, with highly stretchable expanded-polytetrafluoroethylene (ePTFE). In this study, our group comprehensively explored designing and manufacturing methods, and their impact on the stent graft performance. Geometric parameters and heat treatment conditions were investigated to show their effect on the radial force of the metallic backbone. As a retrievable device, the resistance force for retrieval as well as deployment were measured, and analyzed to be manipulated through ePTFE covering configurations. In vitro measurements for bleeding were measured using swine aorta to show the functionality of the stent graft under the simulated pulsatile flow circulation. Finally, the stent graft showed substantial effectiveness for hemorrhage control in vivo, using swine model. The new design and fabrication methods enable rapid hemorrhage control that can be removed at the time of a dedicated surgical repair.
Collapse
Affiliation(s)
- Moataz Elsisy
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Bryan W Tillman
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Catherine Go
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Jenna Kuhn
- McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania
| | - Sung K Cho
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - William W Clark
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| | - Junkyu Park
- Research and Development of Interventional Medicine, CGBIO, Jangseong, Republic of Korea
| | - Youngjae Chun
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania.,McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania
| |
Collapse
|
15
|
Wu MCH, Muchowski HM, Johnson EL, Rajanna MR, Hsu MC. Immersogeometric fluid-structure interaction modeling and simulation of transcatheter aortic valve replacement. COMPUTER METHODS IN APPLIED MECHANICS AND ENGINEERING 2019; 357:112556. [PMID: 32831419 PMCID: PMC7442159 DOI: 10.1016/j.cma.2019.07.025] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
Abstract
The transcatheter aortic valve replacement (TAVR) has emerged as a minimally invasive alternative to surgical treatments of valvular heart disease. TAVR offers many advantages, however, the safe anchoring of the transcatheter heart valve (THV) in the patients anatomy is key to a successful procedure. In this paper, we develop and apply a novel immersogeometric fluid-structure interaction (FSI) framework for the modeling and simulation of the TAVR procedure to study the anchoring ability of the THV. To account for physiological realism, methods are proposed to model and couple the main components of the system, including the arterial wall, blood flow, valve leaflets, skirt, and frame. The THV is first crimped and deployed into an idealized ascending aorta. During the FSI simulation, the radial outward force and friction force between the aortic wall and the THV frame are examined over the entire cardiac cycle. The ratio between these two forces is computed and compared with the experimentally estimated coefficient of friction to study the likelihood of valve migration.
Collapse
Affiliation(s)
- Michael C. H. Wu
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
- School of Engineering, Brown University, 184 Hope Street, Providence, Rhode Island 02912, USA
| | - Heather M. Muchowski
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
- Department of Mathematics, Iowa State University, 396 Carver Hall, Ames, Iowa 50011, USA
| | - Emily L. Johnson
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
| | - Manoj R. Rajanna
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
| | - Ming-Chen Hsu
- Department of Mechanical Engineering, Iowa State University, 2043 Black Engineering, Ames, Iowa 50011, USA
| |
Collapse
|
16
|
Mao W, Wang Q, Kodali S, Sun W. Numerical Parametric Study of Paravalvular Leak Following a Transcatheter Aortic Valve Deployment Into a Patient-Specific Aortic Root. J Biomech Eng 2019; 140:2683660. [PMID: 30029247 DOI: 10.1115/1.4040457] [Citation(s) in RCA: 45] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Indexed: 11/08/2022]
Abstract
Paravalvular leak (PVL) is a relatively frequent complication after transcatheter aortic valve replacement (TAVR) with increased mortality. Currently, there is no effective method to pre-operatively predict and prevent PVL. In this study, we developed a computational model to predict the severity of PVL after TAVR. Nonlinear finite element (FE) method was used to simulate a self-expandable CoreValve deployment into a patient-specific aortic root, specified with human material properties of aortic tissues. Subsequently, computational fluid dynamics (CFD) simulations were performed using the post-TAVR geometries from the FE simulation, and a parametric investigation of the impact of the transcatheter aortic valve (TAV) skirt shape, TAV orientation, and deployment height on PVL was conducted. The predicted PVL was in good agreement with the echocardiography data. Due to the scallop shape of CoreValve skirt, the difference of PVL due to TAV orientation can be as large as 40%. Although the stent thickness is small compared to the aortic annulus size, we found that inappropriate modeling of it can lead to an underestimation of PVL up to 10 ml/beat. Moreover, the deployment height could significantly alter the extent and the distribution of regurgitant jets, which results in a change of leaking volume up to 70%. Further investigation in a large cohort of patients is warranted to verify the accuracy of our model. This study demonstrated that a rigorously developed patient-specific computational model can provide useful insights into underlying mechanisms causing PVL and potentially assist in pre-operative planning for TAVR to minimize PVL.
Collapse
Affiliation(s)
- Wenbin Mao
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30313-2412
| | - Qian Wang
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA 30313-2412
| | - Susheel Kodali
- Division of Cardiology, Columbia University Medical Center, New York 10032
| | - Wei Sun
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, 206 Technology Enterprise Park, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA 30313-2412 e-mail:
| |
Collapse
|
17
|
Luraghi G, Migliavacca F, García-González A, Chiastra C, Rossi A, Cao D, Stefanini G, Rodriguez Matas JF. On the Modeling of Patient-Specific Transcatheter Aortic Valve Replacement: A Fluid-Structure Interaction Approach. Cardiovasc Eng Technol 2019; 10:437-455. [PMID: 31309527 DOI: 10.1007/s13239-019-00427-0] [Citation(s) in RCA: 62] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Accepted: 07/04/2019] [Indexed: 12/14/2022]
Abstract
PURPOSE Transcatheter aortic valve replacement (TAVR) is a minimally invasive treatment for high-risk patients with aortic diseases. Despite its increasing use, many influential factors are still to be understood and require continuous investigation. The best numerical approach capable of reproducing both the valves mechanics and the hemodynamics is the fluid-structure interaction (FSI) modeling. The aim of this work is the development of a patient-specific FSI methodology able to model the implantation phase as well as the valve working conditions during cardiac cycles. METHODS The patient-specific domain, which included the aortic root, native valve and calcifications, was reconstructed from CT images, while the CAD model of the device, metallic frame and pericardium, was drawn from literature data. Ventricular and aortic pressure waveforms, derived from the patient's data, were used as boundary conditions. The proposed method was applied to two real clinical cases, which presented different outcomes in terms of paravalvular leakage (PVL), the main complication after TAVR. RESULTS The results confirmed the clinical prognosis of mild and moderate PVL with coherent values of regurgitant volume and effective regurgitant orifice area. Moreover, the final release configuration of the device and the velocity field were compared with postoperative CT scans and Doppler traces showing a good qualitative and quantitative matching. CONCLUSION In conclusion, the development of realistic and accurate FSI patient-specific models can be used as a support for clinical decisions before the implantation.
Collapse
Affiliation(s)
- Giulia Luraghi
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Piazza L. da Vinci 32, 20133, Milan, Italy.
| | - Francesco Migliavacca
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Piazza L. da Vinci 32, 20133, Milan, Italy
| | - Alberto García-González
- Laboratori de Càlcul Numèric (LaCàN), E.T.S. de Ingenieros de Caminos, Canales y Puertos, Universitat Politècnica de Catalunya (UPC), Jordi Girona 1-3, 08034, Barcelona, Spain
| | - Claudio Chiastra
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Piazza L. da Vinci 32, 20133, Milan, Italy.,PoliToBIOMed Lab, Department of Mechanical and Aerospace Engineering, Politecnico di Torino, Corso Duca degli Abruzzi 24, 10129, Turin, Italy
| | - Alexia Rossi
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Davide Cao
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Giulio Stefanini
- Department of Biomedical Sciences, Humanitas University, via Rita Levi Montalcini 4, 20090, Pieve Emanuele, MI, Italy
| | - Jose Felix Rodriguez Matas
- Laboratory of Biological Structure Mechanics (LaBS), Department of Chemistry, Materials and Chemical Engineering "Giulio Natta", Piazza L. da Vinci 32, 20133, Milan, Italy
| |
Collapse
|
18
|
McGee OM, Sun W, McNamara LM. An in vitro model quantifying the effect of calcification on the tissue–stent interaction in a stenosed aortic root. J Biomech 2019; 82:109-115. [DOI: 10.1016/j.jbiomech.2018.10.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2018] [Revised: 10/11/2018] [Accepted: 10/17/2018] [Indexed: 10/28/2022]
|
19
|
Patient-specific simulation of transcatheter aortic valve replacement: impact of deployment options on paravalvular leakage. Biomech Model Mechanobiol 2018; 18:435-451. [PMID: 30460623 DOI: 10.1007/s10237-018-1094-8] [Citation(s) in RCA: 89] [Impact Index Per Article: 12.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Accepted: 11/01/2018] [Indexed: 10/27/2022]
Abstract
Transcatheter aortic valve replacement (TAVR) has emerged as an effective alternative to conventional surgical valve replacement in high-risk patients afflicted by severe aortic stenosis. Despite newer-generation devices enhancements, post-procedural complications such as paravalvular leakage (PVL) and related thromboembolic events have been hindering TAVR expansion into lower-risk patients. Computational methods can be used to build and simulate patient-specific deployment of transcatheter aortic valves (TAVs) and help predict the occurrence and degree of PVL. In this study finite element analysis and computational fluid dynamics were used to investigate the influence of procedural parameters on post-deployment hemodynamics on three retrospective clinical cases affected by PVL. Specifically, TAV implantation depth and balloon inflation volume effects on stent anchorage, degree of paravalvular regurgitation and thrombogenic potential were analyzed for cases in which Edwards SAPIEN and Medtronic CoreValve were employed. CFD results were in good agreement with corresponding echocardiography data measured in patients in terms of the PVL jets locations and overall PVL degree. Furthermore, parametric analyses demonstrated that positioning and balloon over-expansion may have a direct impact on the post-deployment TAVR performance, achieving as high as 47% in PVL volume reduction. While the model predicted very well clinical data, further validation on a larger cohort of patients is needed to verify the level of the model's predictions in various patient-specific conditions. This study demonstrated that rigorous and realistic patient-specific numerical models could potentially serve as a valuable tool to assist physicians in pre-operative TAVR planning and TAV selection to ultimately reduce the risk of clinical complications.
Collapse
|
20
|
Rotman OM, Bianchi M, Ghosh RP, Kovarovic B, Bluestein D. Principles of TAVR valve design, modelling, and testing. Expert Rev Med Devices 2018; 15:771-791. [PMID: 30318937 PMCID: PMC6417919 DOI: 10.1080/17434440.2018.1536427] [Citation(s) in RCA: 55] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Transcatheter aortic valve replacement (TAVR) has emerged as an effective minimally-invasive alternative to surgical valve replacement in medium- to high-risk, elderly patients with calcific aortic valve disease and severe aortic stenosis. The rapid growth of the TAVR devices market has led to a high variety of designs, each aiming to address persistent complications associated with TAVR valves that may hamper the anticipated expansion of TAVR utility. AREAS COVERED Here we outline the challenges and the technical demands that TAVR devices need to address for achieving the desired expansion, and review design aspects of selected, latest generation, TAVR valves of both clinically-used and investigational devices. We further review in detail some of the up-to-date modeling and testing approaches for TAVR, both computationally and experimentally, and additionally discuss those as complementary approaches to the ISO 5840-3 standard. A comprehensive survey of the prior and up-to-date literature was conducted to cover the most pertaining issues and challenges that TAVR technology faces. EXPERT COMMENTARY The expansion of TAVR over SAVR and to new indications seems more promising than ever. With new challenges to come, new TAV design approaches, and materials used, are expected to emerge, and novel testing/modeling methods to be developed.
Collapse
Affiliation(s)
- Oren M. Rotman
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Matteo Bianchi
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Ram P. Ghosh
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Brandon Kovarovic
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| |
Collapse
|
21
|
Chen Y, Tillman B, Go C, Cho SK, Clark WW, Hur TB, Ding Y, Chun Y. A novel customizable stent graft that contains a stretchable ePTFE with a laser-welded nitinol stent. J Biomed Mater Res B Appl Biomater 2018; 107:911-923. [PMID: 30176119 DOI: 10.1002/jbm.b.34186] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Revised: 05/21/2018] [Accepted: 06/02/2018] [Indexed: 11/11/2022]
Abstract
Customizable medical devices have recently attracted attentions both in dental and orthopedic device fields, which can tailor to the patients' anatomy to reduce the length of surgery time and to improve the clinical outcomes. However, development of the patient specific endovascular device still remains challenging due to the limitations in current 3D printing technology, specifically for the stent grafts. Therefore, our group has investigated the feasibility of a highly stretchable expanded-polytetrafluoroethylene (ePTFE) tube as a customizable graft material with the laser-welded nitinol backbone. In this study, a highly stretchable ePTFE tube was evaluated in terms of mechanical behaviors, in vitro biocompatibility of ePTFE with various stretchiness levels, and capability for the integration with the laser-welded customizable nitinol stent backbone. A prototype stent graft for the swine's venous size was successfully constructed and tested in the porcine model. This study demonstrates the ability of ePTFE tube to customize the stent graft without any significant issue, for example, sweating through the stretched pores in the ePTFE tube, as well as in vivo feasibility of the device for bleeding control. This novel customizable stent graft would offer possibilities for a wide range of both current and next-generation endovascular applications for the treatment in vascular injuries or diseases. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 911-923, 2019.
Collapse
Affiliation(s)
- Yanfei Chen
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261
| | - Bryan Tillman
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15232.,McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15219
| | - Catherine Go
- Division of Vascular Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15232
| | - Sung Kwon Cho
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261
| | - William W Clark
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261
| | - Tae Bong Hur
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261
| | - Yicheng Ding
- Department of Mechanical Engineering and Materials Science, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261
| | - Youngjae Chun
- Department of Industrial Engineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261.,McGowan Institute for Regenerative Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, 15219.,Department of Bioengineering, Swanson School of Engineering, University of Pittsburgh, Pittsburgh, Pennsylvania, 15261
| |
Collapse
|
22
|
The impact of implantation depth of the Lotus™ valve on mechanical stress in close proximity to the bundle of His. Biomech Model Mechanobiol 2018; 18:79-88. [DOI: 10.1007/s10237-018-1069-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2018] [Accepted: 08/01/2018] [Indexed: 10/28/2022]
|
23
|
Bechsgaard T, Lindskow T, Lading T, Hasenkam J, Røpcke D, Nygaard H, Johansen P, L. Nielsen S. Biomechanical characterization of the native porcine aortic root. J Biomech 2018; 74:156-162. [DOI: 10.1016/j.jbiomech.2018.04.037] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 04/02/2018] [Accepted: 04/22/2018] [Indexed: 11/27/2022]
|
24
|
Neuburger PJ, Patel PA. Anesthetic Techniques in Transcatheter Aortic Valve Replacement and the Evolving Role of the Anesthesiologist. J Cardiothorac Vasc Anesth 2017; 31:2175-2182. [DOI: 10.1053/j.jvca.2017.03.033] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2017] [Indexed: 11/11/2022]
|
25
|
Qureshi SH, Boulemden A, Szafranek A, Vohra H. Meta-analysis of sutureless technology versus standard aortic valve replacement and transcatheter aortic valve replacement. Eur J Cardiothorac Surg 2017; 53:463-471. [DOI: 10.1093/ejcts/ezx307] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/03/2017] [Revised: 07/27/2017] [Accepted: 07/30/2017] [Indexed: 11/14/2022] Open
|
26
|
Valve Type, Size, and Deployment Location Affect Hemodynamics in an In Vitro Valve-in-Valve Model. JACC Cardiovasc Interv 2016; 9:1618-28. [DOI: 10.1016/j.jcin.2016.05.030] [Citation(s) in RCA: 57] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/18/2016] [Revised: 05/13/2016] [Accepted: 05/16/2016] [Indexed: 11/20/2022]
|
27
|
Bosi GM, Capelli C, Khambadkone S, Taylor AM, Schievano S. Patient-specific finite element models to support clinical decisions: A lesson learnt from a case study of percutaneous pulmonary valve implantation. Catheter Cardiovasc Interv 2015; 86:1120-30. [PMID: 25855063 DOI: 10.1002/ccd.25944] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/14/2014] [Accepted: 03/14/2015] [Indexed: 11/11/2022]
Abstract
OBJECTIVES AND BACKGROUND Patient-specific finite element (FE) simulations were used to assess different transcatheter valve devices and help select the most appropriate treatment strategy for a patient (17-year-old male) with borderline dimensions for Melody® percutaneous pulmonary valve implantation (PPVI). METHODS AND RESULTS Patient-specific implantation site morphology was derived from cardiovascular magnetic resonance (CMR) images along with the implantation site mechanical behavior by coupling systolic/diastolic dimensions and the pressure gradient in a linear elastic model, and iterative tuning. In this way, the model accounted for the mechanical response not only of the arterial wall, but also of the surrounding tissue. Four stents (2 balloon-expandable including prestenting and 2 self-expandable) were virtually implanted and the stent final configuration, anchoring, migration forces, arterial wall stresses, paravalvular regurgitation, and device mechanical performance were evaluated. A Sapien29 device with prestenting was indicated as the optimal approach for this specific patient as it had a fully open valve, safe anchoring along the entire circumference, low risk of paravalvular leak, and arterial rupture. However, at the time of the PPVI procedure, after balloon sizing, device implantation was suspended due to perceived high risk of device embolization. CONCLUSIONS FE analysis allows a comparison between different treatment scenarios to add information to the clinical decision making process. However, further studies are required to fully predict patient-specific response to stenting and therefore true clinical outcomes.
Collapse
Affiliation(s)
- Giorgia M Bosi
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom
| | - Claudio Capelli
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom
| | - Sachin Khambadkone
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom
| | - Andrew M Taylor
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom
| | - Silvia Schievano
- UCL Institute of Cardiovascular Science & Great Ormond Street Hospital for Children, London, United Kingdom
| |
Collapse
|
28
|
Urena M, Doyle D, Dumont E, Ribeiro HB, Bilodeau S, Rodés-Cabau J. Transcatheter aortic valve replacement with a balloon-expandable valve for the treatment of noncalcified bicuspid aortic valve disease. ACTA ACUST UNITED AC 2014; 67:327-9. [PMID: 24774600 DOI: 10.1016/j.rec.2013.10.014] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2013] [Accepted: 10/18/2013] [Indexed: 11/28/2022]
Affiliation(s)
- Marina Urena
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Daniel Doyle
- Department of Cardiac Surgery, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Eric Dumont
- Department of Cardiac Surgery, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | | | - Sylvie Bilodeau
- Department of Radiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada
| | - Josep Rodés-Cabau
- Department of Cardiology, Quebec Heart & Lung Institute, Laval University, Quebec, Canada.
| |
Collapse
|
29
|
Abstract
In the past two decades, major advances have been made in the clinical evaluation and treatment of valvular heart disease owing to the advent of noninvasive cardiac imaging modalities. In clinical practice, valvular disease evaluation is typically performed on two-dimensional (2D) images, even though most imaging modalities offer three-dimensional (3D) volumetric, time-resolved data. Such 3D data offer researchers the possibility to reconstruct the 3D geometry of heart valves at a patient-specific level. When these data are integrated with computational models, native heart valve biomechanical function can be investigated, and preoperative planning tools can be developed. In this review, we outline the advances in valve geometry reconstruction, tissue property modeling, and loading and boundary definitions for the purpose of realistic computational structural analysis of cardiac valve function and intervention.
Collapse
Affiliation(s)
- Wei Sun
- Tissue Mechanics Lab, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia 30313;
| | | | | |
Collapse
|
30
|
Wang Q, Kodali S, Primiano C, Sun W. Simulations of transcatheter aortic valve implantation: implications for aortic root rupture. Biomech Model Mechanobiol 2014; 14:29-38. [PMID: 24736808 DOI: 10.1007/s10237-014-0583-7] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2014] [Accepted: 03/29/2014] [Indexed: 11/24/2022]
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.
Collapse
Affiliation(s)
- Qian Wang
- Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Technology Enterprise Park Room 206, 387, Technology Circle, Atlanta, GA, 30313-2412, USA
| | | | | | | |
Collapse
|
31
|
Urena M, Doyle D, Dumont E, Ribeiro HB, Bilodeau S, Rodés-Cabau J. Reemplazo percutáneo de la válvula aórtica con una válvula de balón expandible para el tratamiento de la enfermedad valvular aórtica bicúspide no calcificada. Rev Esp Cardiol 2014. [DOI: 10.1016/j.recesp.2013.10.016] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
|
32
|
Nombela-Franco L, Ribeiro HB, Urena M, Pasian S, Allende R, Doyle D, DeLarochellière R, DeLarochellière H, Laflamme L, Laflamme J, Jerez-Valero M, Côté M, Pibarot P, Larose E, Dumont E, Rodés-Cabau J. Incidence, predictive factors and haemodynamic consequences of acute stent recoil following transcatheter aortic valve implantation with a balloon-expandable valve. EUROINTERVENTION 2014; 9:1398-406. [DOI: 10.4244/eijv9i12a237] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
|
33
|
Gessat M, Hopf R, Pollok T, Russ C, Frauenfelder T, Sundermann SH, Hirsch S, Mazza E, Szekely G, Falk V. Image-Based Mechanical Analysis of Stent Deformation: Concept and Exemplary Implementation for Aortic Valve Stents. IEEE Trans Biomed Eng 2014; 61:4-15. [DOI: 10.1109/tbme.2013.2273496] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
|