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Kreinin Y, Talmon Y, Levi M, Khoury M, Or I, Raad M, Bolotin G, Sznitman J, Korin N. A Fibrin-Thrombin Based In Vitro Perfusion System to Study Flow-Related Prosthetic Heart Valves Thrombosis. Ann Biomed Eng 2024; 52:1665-1677. [PMID: 38459196 PMCID: PMC11082030 DOI: 10.1007/s10439-024-03480-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2023] [Accepted: 02/20/2024] [Indexed: 03/10/2024]
Abstract
Prosthetic heart valve (PHV) replacement has increased the survival rate and quality of life for heart valve-diseased patients. However, PHV thrombosis remains a critical problem associated with these procedures. To better understand the PHV flow-related thrombosis problem, appropriate experimental models need to be developed. In this study, we present an in vitro fibrin clot model that mimics clot accumulation in PHVs under relevant hydrodynamic conditions while allowing real-time imaging. We created 3D-printed mechanical aortic valve models that were inserted into a transparent glass aorta model and connected to a system that simulates human aortic flow pulse and pressures. Thrombin was gradually injected into a circulating fibrinogen solution to induce fibrin clot formation, and clot accumulation was quantified via image analysis. The results of valves positioned in a normal versus a tilted configuration showed that clot accumulation correlated with the local flow features and was mainly present in areas of low shear and high residence time, where recirculating flows are dominant, as supported by computational fluid dynamic simulations. Overall, our work suggests that the developed method may provide data on flow-related clot accumulation in PHVs and may contribute to exploring new approaches and valve designs to reduce valve thrombosis.
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Affiliation(s)
- Yevgeniy Kreinin
- Department of Biomedical Engineering, Technion-IIT, 3200003, Haifa, Israel
| | - Yahel Talmon
- Department of Biomedical Engineering, Technion-IIT, 3200003, Haifa, Israel
| | - Moran Levi
- Department of Biomedical Engineering, Technion-IIT, 3200003, Haifa, Israel
| | - Maria Khoury
- Department of Biomedical Engineering, Technion-IIT, 3200003, Haifa, Israel
| | - Itay Or
- Department of Cardiac Surgery, Rambam Health Care Campus, 3109601, Haifa, Israel
| | - Mahli Raad
- Department of Cardiac Surgery, Rambam Health Care Campus, 3109601, Haifa, Israel
| | - Gil Bolotin
- Department of Cardiac Surgery, Rambam Health Care Campus, 3109601, Haifa, Israel
- The Ruth Bruce Rappaport Faculty of Medicine, Technion-IIT, 3525433, Haifa, Israel
| | - Josué Sznitman
- Department of Biomedical Engineering, Technion-IIT, 3200003, Haifa, Israel
| | - Netanel Korin
- Department of Biomedical Engineering, Technion-IIT, 3200003, Haifa, Israel.
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2
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Natarajan T, Singh-Gryzbon S, Chen H, Sadri V, Ruile P, Neumann FJ, Yoganathan AP, Dasi LP. Sensitivity of Post-TAVR Hemodynamics to the Distal Aortic Arch Anatomy: A High-Fidelity CFD Study. Cardiovasc Eng Technol 2024:10.1007/s13239-024-00728-z. [PMID: 38653932 DOI: 10.1007/s13239-024-00728-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 03/22/2024] [Indexed: 04/25/2024]
Abstract
PURPOSE Patient-specific simulations of transcatheter aortic valve (TAV) using computational fluid dynamics (CFD) often rely on assumptions regarding proximal and distal anatomy due to the limited availability of high-resolution imaging away from the TAV site and the primary research focus being near the TAV. However, the influence of these anatomical assumptions on computational efficiency and resulting flow characteristics remains uncertain. This study aimed to investigate the impact of different distal aortic arch anatomies-some of them commonly used in literature-on flow and hemodynamics in the vicinity of the TAV using large eddy simulations (LES). METHODS Three aortic root anatomical configurations with four representative distal aortic arch types were considered in this study. The arch types included a 90-degree bend, an idealized distal aortic arch anatomy, a clipped version of the idealized distal aortic arch, and an anatomy extruded along the normal of segmented anatomical boundary. Hemodynamic parameters both instantaneous and time-averaged such as Wall Shear Stress (WSS), and Oscillatory Shear Index (OSI) were derived and compared from high-fidelity CFD data. RESULTS While there were minor differences in flow and hemodynamics across the configurations examined, they were generally not significant within our region of interest i.e., the aortic root. The choice of extension type had a modest impact on TAV hemodynamics, especially in the vicinity of the TAV with variations observed in local flow patterns and parameters near the TAV. However, these differences were not substantial enough to cause significant deviations in the overall flow and hemodynamic characteristics. CONCLUSIONS The results suggest that under the given configuration and boundary conditions, the type of outflow extension had a modest impact on hemodynamics proximal to the TAV. The findings contribute to a better understanding of flow dynamics in TAV configurations, providing insights for future studies in TAV-related experiments as well as numerical simulations. Additionally, they help mitigate the uncertainties associated with patient-specific geometries, offering increased flexibility in computational modeling.
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Affiliation(s)
- Thangam Natarajan
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Shelly Singh-Gryzbon
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
- Department of Chemical Engineering, University of the West Indies, St.Augustine, Trinidad and Tobago
| | - Huang Chen
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Vahid Sadri
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
- Abbott Laboratories, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Philipp Ruile
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology, Medical Center - University of Freiburg, and Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Ajit P Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313-2412, USA
| | - Lakshmi P Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313-2412, USA.
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3
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Morany A, Bardon RG, Lavon K, Hamdan A, Bluestein D, Haj-Ali R. Analysis of fibrocalcific aortic valve stenosis: computational pre-and-post TAVR haemodynamics behaviours. ROYAL SOCIETY OPEN SCIENCE 2024; 11:230905. [PMID: 38384780 PMCID: PMC10878817 DOI: 10.1098/rsos.230905] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Figures] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 01/22/2024] [Indexed: 02/23/2024]
Abstract
Fibro-calcific aortic valve (AV) diseases are characterized by calcium growth or accumulation of fibrosis in the AV tissues. Fibrocalcific aortic stenosis (FAS) rises specifically in females, like calcification-induced aortic stenosis (CAS), may eventually necessitate valve replacement. Fluid-structure-interaction (FSI) computational models for severe CAS and FAS patients were developed using lattice Boltzmann method and multi-scale finite elements (FE). Three parametric AV models were introduced: pathology-free of non-calcified tri-and-bicuspid AVs with healthy collagen fibre network (CFN), a FAS model incorporated a thickened CFN with embedded small calcification volumes, and a CAS model employs healthy CFN with embedded high calcification volumes. The results indicate that the interaction between calcium deposits, adjacent tissue and fibres crucially influences haemodynamics and structural reactions. A fourth model of transcatheter aortic valve replacement (TAVR) post-procedure outcomes was created to study both CAS and FAS. TAVR-CAS had a higher maximum contact pressure and lower anchoring area than TAVR-FAS, making it prone to aortic tissue damage and migration. Finally, although the TAVR-CAS offered a larger opening area, its paravalvular leakage was higher. This may be attributed to a similar thrombogenicity potential characterizing both models. The computational framework emphasizes the significance of mechanobiology in FAS and underscores the requirement for tissue modelling at multiple scales.
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Affiliation(s)
- Adi Morany
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Karin Lavon
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
| | - Ashraf Hamdan
- Department of Cardiology, Rabin Medical Center, Petach Tikva, Faculty of Medicine, Tel Aviv University, Tel Aviv 6997801, Israel
| | - Danny Bluestein
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
| | - Rami Haj-Ali
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel
- Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, USA
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4
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Asadbeygi A, Lee S, Kovalchin J, Hatoum H. Effect of Beta Blockers on the Hemodynamics and Thrombotic Risk of Coronary Artery Aneurysms in Kawasaki Disease. J Cardiovasc Transl Res 2023; 16:852-861. [PMID: 36932263 DOI: 10.1007/s12265-023-10370-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2022] [Accepted: 03/06/2023] [Indexed: 03/19/2023]
Abstract
This study aims to simulate beta blockers' (BB) effects on coronary artery aneurysms' (CAA) hemodynamics and thrombotic risk in Kawasaki disease (KD). BB are recommended in cases of large aneurysms due to their anti-ischemic effect. Coronary blood flow (CBF) was simulated in KD patient-specific CAA models using computational fluid dynamics. Hemodynamic indices that correlate with thrombotic risk were calculated following two possible responses to BB: (1) preserved coronary flow (third BB generation) and (2) reduction in coronary flow (first and second BB generations) at reduced heart rate. Following CBF reduction scenario, mean TAWSS and HOLMES significantly decreased compared to normal conditions, leading to a potential increase in thrombotic risk. Preserved CBF at lower heart rates, mimicking the response to vasodilating BBs, does not significantly affect local CAA hemodynamics compared with baseline, while achieving the desired anti-ischemic effects. Different BB generations lead to different hemodynamic responses in CAA.
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Affiliation(s)
- Alireza Asadbeygi
- Department of Biomedical Engineering, Michigan Technological University, 1400 Townsend Dr , Houghton, MI, 49931, USA
| | - Simon Lee
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - John Kovalchin
- Department of Pediatrics, Nationwide Children's Hospital, Columbus, OH, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, 1400 Townsend Dr , Houghton, MI, 49931, USA.
- Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, MI, USA.
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Kim HJ, Rundfeldt HC, Lee I, Lee S. Tissue-growth-based synthetic tree generation and perfusion simulation. Biomech Model Mechanobiol 2023; 22:1095-1112. [PMID: 36869925 PMCID: PMC10167159 DOI: 10.1007/s10237-023-01703-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 02/10/2023] [Indexed: 03/05/2023]
Abstract
Biological tissues receive oxygen and nutrients from blood vessels by developing an indispensable supply and demand relationship with the blood vessels. We implemented a synthetic tree generation algorithm by considering the interactions between the tissues and blood vessels. We first segment major arteries using medical image data and synthetic trees are generated originating from these segmented arteries. They grow into extensive networks of small vessels to fill the supplied tissues and satisfy the metabolic demand of them. Further, the algorithm is optimized to be executed in parallel without affecting the generated tree volumes. The generated vascular trees are used to simulate blood perfusion in the tissues by performing multiscale blood flow simulations. One-dimensional blood flow equations were used to solve for blood flow and pressure in the generated vascular trees and Darcy flow equations were solved for blood perfusion in the tissues using a porous model assumption. Both equations are coupled at terminal segments explicitly. The proposed methods were applied to idealized models with different tree resolutions and metabolic demands for validation. The methods demonstrated that realistic synthetic trees were generated with significantly less computational expense compared to that of a constrained constructive optimization method. The methods were then applied to cerebrovascular arteries supplying a human brain and coronary arteries supplying the left and right ventricles to demonstrate the capabilities of the proposed methods. The proposed methods can be utilized to quantify tissue perfusion and predict areas prone to ischemia in patient-specific geometries.
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Affiliation(s)
- Hyun Jin Kim
- Mechanical Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea.
| | - Hans Christian Rundfeldt
- Mechanical Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
- Mechanical Engineering, Kalsruhe Institute of Technology, Kaiserstraße 12, Karlsruhe, 76131, Germany
| | - Inpyo Lee
- Mechanical Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
| | - Seungmin Lee
- Mechanical Engineering, Korea Advanced Institute of Science and Technology, 291 Daehak-ro, Yuseong-gu, Daejeon, 34141, Republic of Korea
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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: 0] [Impact Index Per Article: 0] [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.
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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.
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7
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Barrett A, Brown JA, Smith MA, Woodward A, Vavalle JP, Kheradvar A, Griffith BE, Fogelson AL. A model of fluid-structure and biochemical interactions for applications to subclinical leaflet thrombosis. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2023; 39:e3700. [PMID: 37016277 PMCID: PMC10691439 DOI: 10.1002/cnm.3700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/06/2022] [Revised: 02/10/2023] [Accepted: 02/20/2023] [Indexed: 05/13/2023]
Abstract
Subclinical leaflet thrombosis (SLT) is a potentially serious complication of aortic valve replacement with a bioprosthetic valve in which blood clots form on the replacement valve. SLT is associated with increased risk of transient ischemic attacks and strokes and can progress to clinical leaflet thrombosis. SLT following aortic valve replacement also may be related to subsequent structural valve deterioration, which can impair the durability of the valve replacement. Because of the difficulty in clinical imaging of SLT, models are needed to determine the mechanisms of SLT and could eventually predict which patients will develop SLT. To this end, we develop methods to simulate leaflet thrombosis that combine fluid-structure interaction and a simplified thrombosis model that allows for deposition along the moving leaflets. Additionally, this model can be adapted to model deposition or absorption along other moving boundaries. We present convergence results and quantify the model's ability to realize changes in valve opening and pressures. These new approaches are an important advancement in our tools for modeling thrombosis because they incorporate both adhesion to the surface of the moving leaflets and feedback to the fluid-structure interaction.
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Affiliation(s)
- Aaron Barrett
- Department of Mathematics, University of Utah, Salt Lake City, Utah, USA
| | - Jordan A. Brown
- Department of Mathematics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Margaret Anne Smith
- Department of Mathematics, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Andrew Woodward
- Advanced Medical Imaging Lab, University of North Carolina Medical Center, Chapel Hill, North Carolina, USA
| | - John P. Vavalle
- University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
- Division of Cardiology, Department of Medicine, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Arash Kheradvar
- Department of Biomedical Engineering, University of California Irvine, Irvine, California, USA
| | - Boyce E. Griffith
- Departments of Mathematics, Applied Physical Sciences, and Biomedical Engineering, University of North Carolina, Chapel Hill, North Carolina, USA
- Carolina Center for Interdisciplinary Applied Mathematics, University of North Carolina, Chapel Hill, North Carolina, USA
- Computational Medicine Program, University of North Carolina, Chapel Hill, North Carolina, USA
- McAllister Heart Institute, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Aaron L. Fogelson
- Departments of Mathematics and Biomedical Engineering, University of Utah, Salt Lake City, Utah, USA
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8
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Kovarovic BJ, Rotman OM, Parikh PB, Slepian MJ, Bluestein D. Mild Paravalvular Leak May Pose an Increased Thrombogenic Risk in Transcatheter Aortic Valve Replacement (TAVR) Patients-Insights from Patient Specific In Vitro and In Silico Studies. Bioengineering (Basel) 2023; 10:bioengineering10020188. [PMID: 36829682 PMCID: PMC9952825 DOI: 10.3390/bioengineering10020188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Revised: 01/27/2023] [Accepted: 01/30/2023] [Indexed: 02/05/2023] Open
Abstract
In recent years, the treatment of aortic stenosis with TAVR has rapidly expanded to younger and lower-risk patients. However, persistent thrombotic events such as stroke and valve thrombosis expose recipients to severe clinical complications that hamper TAVR's rapid advance. We presented a novel methodology for establishing a link between commonly acceptable mild paravalvular leak (PVL) levels through the device and increased thrombogenic risk. It utilizes in vitro patient-specific TAVR 3D-printed replicas evaluated for hydrodynamic performance. High-resolution µCT scans are used to reconstruct in silico FSI models of these replicas, in which multiple platelet trajectories are studied through the PVL channels to quantify thrombogenicity, showing that those are highly dependent on patient-specific flow conditions within the PVL channels. It demonstrates that platelets have the potential to enter the PVL channels multiple times over successive cardiac cycles, increasing the thrombogenic risk. This cannot be reliably approximated by standard hemodynamic parameters. It highlights the shortcomings of subjectively ranked PVL commonly used in clinical practice by indicating an increased thrombogenic risk in patient cases otherwise classified as mild PVL. It reiterates the need for more rigorous clinical evaluation for properly diagnosing thrombogenic risk in TAVR patients.
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Affiliation(s)
- Brandon J. Kovarovic
- Biofluids Research Group, Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Oren M. Rotman
- Biofluids Research Group, Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
| | - Puja B. Parikh
- Division of Cardiovascular Medicine, Department of Medicine, Stony Brook University, Stony Brook, NY 11794, USA
| | - Marvin J. Slepian
- Department of Medicine, Sarver Heart Center, University of Arizona, Tucson, AZ 85724, USA
- Department of Biomedical Engineering, College of Engineering, University of Arizona, Tucson, AZ 85721, USA
| | - Danny Bluestein
- Biofluids Research Group, Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY 11794, USA
- Correspondence:
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9
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Oks D, Samaniego C, Houzeaux G, Butakoff C, Vázquez M. Fluid-structure interaction analysis of eccentricity and leaflet rigidity on thrombosis biomarkers in bioprosthetic aortic valve replacements. INTERNATIONAL JOURNAL FOR NUMERICAL METHODS IN BIOMEDICAL ENGINEERING 2022; 38:e3649. [PMID: 36106918 DOI: 10.1002/cnm.3649] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/01/2022] [Revised: 08/11/2022] [Accepted: 09/04/2022] [Indexed: 06/15/2023]
Abstract
This work intends to study the effect of aortic annulus eccentricity and leaflet rigidity on the performance, thrombogenic risk and calcification risk in bioprosthetic aortic valve replacements (BAVRs). To address these questions, a two-way immersed fluid-structure interaction (FSI) computational model was implemented in a high-performance computing (HPC) multi-physics simulation software, and validated against a well-known FSI benchmark. The aortic valve bioprosthesis model is qualitatively contrasted against experimental data, showing good agreement in closed and open states. Regarding the performance of BAVRs, the model predicts that increasing eccentricities yield lower geometric orifice areas (GOAs) and higher normalized transvalvular pressure gradients (TPGs) for healthy cardiac outputs during systole, agreeing with in vitro experiments. Regions with peak values of residence time are observed to grow with eccentricity in the sinus of Valsalva, indicating an elevated risk of thrombus formation for eccentric configurations. In addition, the computational model is used to analyze the effect of varying leaflet rigidity on both performance, thrombogenic and calcification risks with applications to tissue-engineered prostheses. For more rigid leaflets it predicts an increase in systolic and diastolic TPGs, and decrease in systolic GOA, which translates to decreased valve performance. The peak shear rate and residence time regions increase with leaflet rigidity, but their volume-averaged values were not significantly affected. Peak solid stresses are also analyzed, and observed to increase with rigidity, elevating risk of valve calcification and structural failure. To the authors' knowledge this is the first computational FSI model to study the effect of eccentricity or leaflet rigidity on thrombogenic biomarkers, providing a novel tool to aid device manufacturers and clinical practitioners.
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Affiliation(s)
- David Oks
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Cristóbal Samaniego
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | - Guillaume Houzeaux
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
| | | | - Mariano Vázquez
- Department of Computer Applications in Science and Engineering, Barcelona Supercomputing Center (BSC), Barcelona, Spain
- ELEM Biotech SL, Barcelona, Spain
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10
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Esmailie F, Razavi A, Yeats B, Sivakumar SK, Chen H, Samaee M, Shah IA, Veneziani A, Yadav P, Thourani VH, Dasi LP. Biomechanics of Transcatheter Aortic Valve Replacement Complications and Computational Predictive Modeling. STRUCTURAL HEART : THE JOURNAL OF THE HEART TEAM 2022; 6:100032. [PMID: 37273734 PMCID: PMC10236878 DOI: 10.1016/j.shj.2022.100032] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Revised: 10/09/2021] [Accepted: 11/03/2021] [Indexed: 06/06/2023]
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.
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Affiliation(s)
- Fateme Esmailie
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Atefeh Razavi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Breandan Yeats
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Sri Krishna Sivakumar
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Huang Chen
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Milad Samaee
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Imran A. Shah
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
| | - Alessandro Veneziani
- Department of Mathematics, Department of Computer Science, Emory University, Atlanta, Georgia, USA
| | - Pradeep Yadav
- Department of Cardiology, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Vinod H. Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Lakshmi Prasad Dasi
- The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology/Emory University School of Medicine, Atlanta, Georgia, USA
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11
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Image Registration-Based Method for Reconstructing Transcatheter Heart Valve Geometry from Patient-Specific CT Scans. Ann Biomed Eng 2022; 50:805-815. [DOI: 10.1007/s10439-022-02962-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2022] [Accepted: 03/30/2022] [Indexed: 01/18/2023]
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12
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Hatoum H, Singh-Gryzbon S, Esmailie F, Ruile P, Neumann FJ, Blanke P, Thourani VH, Yoganathan AP, Dasi LP. Predictive Model for Thrombus Formation After Transcatheter Valve Replacement. Cardiovasc Eng Technol 2021; 12:576-588. [PMID: 34859378 PMCID: PMC11034843 DOI: 10.1007/s13239-021-00596-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 11/09/2021] [Indexed: 12/27/2022]
Abstract
PURPOSE Leaflet thrombosis is a significant adverse event after transcatheter aortic valve (TAV) replacement (TAVR). The purpose of our study was to present a semi-empirical, mathematical model that links patient-specific anatomic, valve, and flow parameters to predict likelihood of leaflet thrombosis. METHODS The two main energy sources of neo-sinus (NS) washout after TAVR include the jet flow downstream of the TAV and NS geometric change in volume due to the leaflets opening and closing. Both are highly dependent on patient anatomic and hemodynamic factors. As rotation of blood flow is prevalent in both the sinus of Valsalva and then the NS, we adopted the vorticity flux or circulation (Г) as a metric quantifying overall washout. Leaflet thrombus volumes were segmented based on hypo-attenuating leaflet thickening (HALT) in post-TAVR patient's gated computed tomography. Г was assessed using dimensional scaling as well as computational fluid dynamics (CFD) respectively and correlated to the thrombosis volumes using sensitivity and specificity analysis. RESULTS Г in the NS, that accounted for patient flow and anatomic conditions derived from scaling arguments significantly better predicted the occurrence of leaflet thrombus than CFD derived measures such as stasis volumes or wall shear stress. Given results from the six patient datasets considered herein, a threshold Г value of 28.0 yielded a sensitivity and specificity of 100% where patients with Gamma < 28 developed valve thrombosis. A 10% error in measurements of all variables can bring the sensitivity specificity down to 87%. CONCLUSION A predictive model relating likelihood of valve thrombosis using Г in the NS was developed with promising sensitivity and specificity. With further studies and improvements, this predictive technology may lead to alerting physicians on the risk for thrombus formation following TAVR.
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Affiliation(s)
- Hoda Hatoum
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
- Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA
| | - Shelly Singh-Gryzbon
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
- Department of Chemical & Process Engineering, The University of the West Indies, St Augustine, Trinidad and Tobago
| | - Fateme Esmailie
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
| | - Philipp Ruile
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Franz-Josef Neumann
- Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany
| | - Philipp Blanke
- University of British Columbia and St. Paul's Hospital in Vancouver, Vancouver, Canada
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA
| | - Ajit P Yoganathan
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA
| | - Lakshmi Prasad Dasi
- Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA.
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Yaakobovich H, Plitman Mayo R, Zaretsky U, Finkelstein A, Weiss D, Marom G. The effect of clinically recommended Evolut sizes on anchorage forces after BASILICA. J Biomech 2021; 118:110303. [PMID: 33601185 DOI: 10.1016/j.jbiomech.2021.110303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2020] [Accepted: 01/16/2021] [Indexed: 11/28/2022]
Abstract
Coronary artery obstruction (CAO), a fatal complication of transcatheter aortic valve replacement (TAVR), is commonly found after Valve-in-Valve implantation inside a degenerated bioprosthetic valve. Leaflet laceration (BASILICA technique) has been proposed to prevent CAO and to potentially reduce the risk of leaflet thrombosis. We have previously demonstrated that this technique can reduce the anchorage forces of the TAVR device, which may lead to future complications. In this short communication, we hypothesize that the anchorage force reduction can be minimized by implanting a TAVR with a larger diameter, if two sizes are clinically recommended. We evaluated this hypothesis by employing finite element models of the deployments of the Evolut 26 and 29 mm inside a 27 mm Mitroflow valve, with and without leaflet lacerations. The results show that a laceration substantially decreases the contact area between the Evolut stent and the Mitroflow valve. The larger Evolut has a larger contact area and stronger anchorage forces. Additionally, the anchorage forces are less sensitive to additional lacerations in the larger Evolut (29 case). The results suggest that a larger self-expending device can ensure stronger anchorage and can lower the risk of possible migration, when TAVR is performed in a lacerated bioprosthesis.
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Affiliation(s)
- Halit Yaakobovich
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Uri Zaretsky
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Dar Weiss
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel; Department of Biomedical Engineering, Yale University, CT, USA
| | - Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel.
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14
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Plitman Mayo R, Yaakobovich H, Finkelstein A, Shadden SC, Marom G. Impact of BASILICA on the thrombogenicity potential of valve-in-valve implantations. J Biomech 2021; 118:110309. [PMID: 33601181 DOI: 10.1016/j.jbiomech.2021.110309] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2021] [Accepted: 02/03/2021] [Indexed: 01/17/2023]
Abstract
Subclinical leaflet thrombosis is becoming a major concern in valve-in-valve procedures, whereby a transcatheter aortic valve device is deployed inside a failed bioprosthetic surgical valve. Blood flow stagnation and prolonged residence times in the neo-sinuses have been suggested as possible explanations for leaflet thrombosis. The BASILICA technique, which was originally developed to treat coronary flow obstruction, has also been proposed as an alternative to reduce the risk of thrombus formation. The aim of this study is to understand the impact of BASILICA on the valve-in-valve thrombogenicity using computational fluid dynamics simulations. To this end, two Eulerian and two Lagrangian approaches were employed to estimate near-wall stagnation measures in eight valve-in-valve models. The models included an intact or lacerated Sorin Mitroflow surgical valve, and either a SAPIEN or Evolut transcatheter aortic valve device. The Lagrangian approaches predicted a high number of particles and vortices concentration in the proximal areas of the neo-sinuses, while the Eulerian approaches did so in the distal areas. As a consequence, this study demonstrated that Lagrangian approaches are better predictors of subclinical leaflet thrombosis, since they match experimental and clinical findings. Additionally, the SAPIEN valve possess a higher risk for developing leaflet thrombosis, and two lacerations are shown to provide the best results in terms of development of vortices and accumulation of particles within the neo-sinuses. This study highlights the potential of computational modeling in aiding clinicians in their decision-making in valve-in-valve and BASILICA procedures.
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Affiliation(s)
| | - Halit Yaakobovich
- Department of Biomedical Engineering, Tel Aviv University, Tel Aviv, Israel
| | | | - Shawn C Shadden
- Department of Mechanical Engineering, University of California, Berkeley, CA, USA
| | - Gil Marom
- School of Mechanical Engineering, Tel Aviv University, Tel Aviv, Israel.
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