Assessment of Paravalvular Leak Severity and Thrombogenic Potential in Transcatheter Bicuspid Aortic Valve Replacements Using Patient-Specific Computational Modeling

Abstract

Bicuspid aortic valve (BAV), the most common congenital valvular abnormality, generates asymmetric flow patterns and increased stresses on the leaflets that expedite valvular calcification and structural degeneration. Recently adapted for use in BAV patients, TAVR demonstrates promising performance, but post-TAVR complications tend to get exacerbated due to BAV anatomical complexities. Utilizing patient-specific computational modeling, we address some of these complications. The degree and location of post-TAVR PVL was assessed, and the risk of flow-induced thrombogenicity was analyzed in 3 BAV patients -using older generation TAVR devices that were implanted in these patients, and compared them to the performance of the newest generation TAVR devices using in silico patient models. Significant decrease in PVL and thrombogenic potential was observed after implantation of the newest generation device. The current work demonstrates the potential of using simulations in pre-procedural planning to assess post-TAVR complications, and compare the performance of different devices to achieve better clinical outcomes.

Effect of Sinotubular Junction Size on TAVR Leaflet Thrombosis: A Fluid-structure Interaction Analysis

“…Commissural alignment was ensured during the deployment process. Detailed information on the TAVR crimping and deployment simulations can be found in our previous studies [22, 33, 34, 48]. Subsequently, the resultant geometries of the deployed systems were exported as STLs, which were in turn used to construct the boundary and volume meshes with ANSA BETA CAE [49], with dimensions specified in Table 1.…”

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

“…The link between thrombosis in TAVR and PVL was initially investigated in several in silico computational fluid dynamics (CFD) simulations [22][23][24][25]. PVL has been replicated with a patient-specific in vitro flow model, giving the ability for further in-depth study of the clinical scenarios for device comparison [26][27][28].…”

“…PVL has been replicated with a patient-specific in vitro flow model, giving the ability for further in-depth study of the clinical scenarios for device comparison [26][27][28]. The in silico models have relied on initial structural finite element simulations to estimate deployment of the TAVR device in the patient anatomy, and the resulting PVL channels could only be compared to echo/Doppler imaging which is limited in resolution and accuracy of flow velocity [23,24,26]. These studies have utilized device thrombogenic emulation (DTE) methodology in which a particle model is used to estimate platelet trajectories, and stress accumulation along the trajectory is collapsed into a probability of device thrombogenicity or the device thrombogenic footprint [29][30][31][32].…”

“…These studies have utilized device thrombogenic emulation (DTE) methodology in which a particle model is used to estimate platelet trajectories, and stress accumulation along the trajectory is collapsed into a probability of device thrombogenicity or the device thrombogenic footprint [29][30][31][32]. In these studies, platelets were seeded in the blood flow field during diastole, and their individual trajectories were tracked over a single wash through the channels-indicating a significant increase in the device thrombogenic potential due to the leak [23][24][25].…”

Modelling blood flow in patients with heart valve disease using deep learning: A computationally efficient method to expand diagnostic capabilities in clinical routine

“…In the case of aortic valve disease specifically, CFD simulations are used to predict hemodynamic parameters which may be critical to clinical outcome. These include, but are not limited to, paravalvular leakage (18)(19)(20), pressure and wall-shearstress (WSS) in the aorta after aortic valve replacement for different valve types and sizes (21,22) as well flow patterns generated by different valve diseases and prosthesis types (15,23).…”