Computational comparison of aortic root stresses in presence of stentless and stented aortic valve bio-prostheses

Nestola, Maria Giuseppina Chiara; Faggiano, Elena; Vergara, Christian; Lancellotti, Rocco Michele; Ippolito, Sonia; Antona, Carlo; Filippi, Sandra; Quarteroni, Alfio; Scrofani, Roberto

doi:10.1080/10255842.2016.1207171

Cited by 20 publications

(12 citation statements)

References 52 publications

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“…The efficacy of the model is assessed by comparison with patient imaging data. Recently, a study using an Arbitrary Lagrangian-Eulerian (ALE) approach compared the performance of native valves as well as stentless and stented bioprosthetic valves in realistic patient anatomies [24].…”

Section: Introductionmentioning

confidence: 99%

Image-based immersed boundary model of the aortic root

Hasan

Kolahdouz

Enquobahrie

et al. 2017

Medical Engineering & Physics

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Each year, approximately 300,000 heart valve repair or replacement procedures are performed worldwide, including approximately 70,000 aortic valve replacement surgeries in the United States alone. Computational platforms for simulating cardiovascular devices such as prosthetic heart valves promise to improve device design and assist in treatment planning, including patient-specific device selection. This paper describes progress in constructing anatomically and physiologically realistic immersed boundary (IB) models of the dynamics of the aortic root and ascending aorta. This work builds on earlier IB models of fluid-structure interaction (FSI) in the aortic root, which previously achieved realistic hemodynamics over multiple cardiac cycles, but which also were limited to simplified aortic geometries and idealized descriptions of the biomechanics of the aortic valve cusps. By contrast, the model described herein uses an anatomical geometry reconstructed from patient-specific computed tomography angiography (CTA) data, and employs a description of the elasticity of the aortic valve leaflets based on a fiber-reinforced constitutive model fit to experimental tensile test data. The resulting model generates physiological pressures in both systole and diastole, and yields realistic cardiac output and stroke volume at physiological Reynolds numbers. Contact between the valve leaflets during diastole is handled automatically by the IB method, yielding a fully competent valve model that supports a physiological diastolic pressure load without regurgitation. Numerical tests show that the model is able to resolve the leaflet biomechanics in diastole and early systole at practical grid spacings. The model is also used to examine differences in the mechanics and fluid dynamics yielded by fresh valve leaflets and glutaraldehyde-fixed leaflets similar to those used in bioprosthetic heart valves. Although there are large differences in the leaflet deformations during diastole, the differences in the open configurations of the valve models are relatively small, and nearly identical hemodynamics are obtained in all cases considered.

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Section: Introductionmentioning

confidence: 99%

Image-based immersed boundary model of the aortic root

Hasan

Kolahdouz

Enquobahrie

et al. 2017

Medical Engineering & Physics

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“…Работы выполняли как на лабораторных животных [6], так и при изучении корня аорты здоровых людей [8]. Аналогичные методы легли в основу математического моделирования различных сценариев поведения пара-вальвулярных структур корня аорты, демонстрирующих напряжение сосудистой стенки в зоне имплантации биопротезов различных модификаций [9].…”

Section: Discussionunclassified

Deformational dynamics of the aortic root in elderly patients after aortic valve replacement with biological prostheses

Демидов¹,

Astaspov²,

Bogachev-Prokophiev³

et al. 2017

PKiK

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Aim. The study was designed to comparatively assess dynamic changes of the aortic root structures depending on a phase of the cardiac cycle in patients with degenerative aortic stenosis, who underwent aortic valve replacement with different types of biological prostheses. Methods. This prospective parallel controlled randomized trial study was performed at Meshalkin National Medical Research Center over a period from 2011 to 2015. The inclusion criteria were severe aortic stenosis and patients’ age older than 65 years. 114 patients were randomized 1:1 in two groups: group I included 57 patients with stentless biological prostheses, while group II (control one) consisted of 57 patients with stented xenopericardial prostheses. The average age was 71 [66; 74] and 72 [69; 77] for the first and second groups, respectively (p = 0.054). All patients underwent aortic valve replacement. The operation was performed under standard normothermic cardiopulmonary bypass. The diameter of the implanted prostheses was 25 mm [24; 26] and 23 mm [21; 23] for the first and second groups, respectively (p = 0.375). An ECG-synchronized CT study of the aortic root was carried out in the postoperative period. Results. An intergroup systolic/diastolic difference in the values of the cross-sectional area of the aortic root at all levels was observed in patients with stentless bioprostheses, while the control group patients (with stented bioprostheses) had no such difference at the levels of the left ventricle output tract and the fibrous ring of the aortic valve. Conclusion. A stentless design of bioprostheses retains the deformational and elastic properties of the aortic root in elderly patients with aortic valve stenosis after surgical treatment.Received 5 December 2017. Revised 12 December 2017. Accepted 15 December 2017.Funding: The study did not have sponsorship.Conflict of interest: The authors declare no conflict of interest.Author contributions Conception and study design: D.P. Demidov, D.A. Astapov, A.V. Bogachev-Prokophiev Data collection and analysis: D.P. Demidov Drafting the article: D.P. Demidov Critical revision of the article: D.A. Astapov, A.V. Bogachev-Prokophiev Final approval of the version to be published: D.A. Astapov, A.V. Bogachev-Prokophiev, S.I. Zheleznev, A.M. Karaskov

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“…Faggiano et al (2013). For an example, see Bazilevs et al (2009), and Nestola et al (2017) for the flow simulation in the aorta and Khalafvand et al (2014) for that in the left ventricle. A more realistic situation is obtained by simulating the opening/closure mechanism of the aortic valve orifice by means of the following conditions prescribed to the fluid problem: if P u > P d then the valve opens, if Q d < 0 then the valve closes, (7.34)…”

Section: Reduced Models For Fluid-valve Interactionmentioning

confidence: 99%

The cardiovascular system: Mathematical modelling, numerical algorithms and clinical applications

Quarteroni

Manzoni

Vergara³

2017

Acta Numerica

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194

125

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Mathematical and numerical modelling of the cardiovascular system is a research topic that has attracted remarkable interest from the mathematical community because of its intrinsic mathematical difficulty and the increasing impact of cardiovascular diseases worldwide. In this review article we will address the two principal components of the cardiovascular system: arterial circulation and heart function. We will systematically describe all aspects of the problem, ranging from data imaging acquisition, stating the basic physical principles, analysing the associated mathematical models that comprise PDE and ODE systems, proposing sound and efficient numerical methods for their approximation, and simulating both benchmark problems and clinically inspired problems. Mathematical modelling itself imposes tremendous challenges, due to the amazing complexity of the cardiocirculatory system, the multiscale nature of the physiological processes involved, and the need to devise computational methods that are stable, reliable and efficient. Critical issues involve filtering the data, identifying the parameters of mathematical models, devising optimal treatments and accounting for uncertainties. For this reason, we will devote the last part of the paper to control and inverse problems, including parameter estimation, uncertainty quantification and the development of reduced-order models that are of paramount importance when solving problems with high complexity, which would otherwise be out of reach.

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Computational comparison of aortic root stresses in presence of stentless and stented aortic valve bio-prostheses

Cited by 20 publications

References 52 publications

Image-based immersed boundary model of the aortic root

Image-based immersed boundary model of the aortic root

Deformational dynamics of the aortic root in elderly patients after aortic valve replacement with biological prostheses

The cardiovascular system: Mathematical modelling, numerical algorithms and clinical applications

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