Patient-Specific Computer Simulation to Elucidate the Role of Contact Pressure in the Development of New Conduction Abnormalities After Catheter-Based Implantation of a Self-Expanding Aortic Valve

Rocatello, Giorgia; Faquir, Nahid El; Santis, Gianluca De; Iannaccone, Francesco; Bosmans, Johan; Backer, Ole De; Søndergaard, Lars; Segers, Patrick; Beule, Matthieu De; Jaegere, Peter de; Mortier, Peter

doi:10.1161/circinterventions.117.005344

Cited by 87 publications

(107 citation statements)

References 25 publications

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“…Patient‐specific computational models containing LVOT, calcified native leaflets, ascending aorta, and coronary arteries were generated on the basis of routine preoperative MDCT images (Mimics version 18.0, Materialize, Leuven, Belgium). Subsequently, finite‐element computer modeling (Abaqus/Explicit version 6.12, Dassault Systèmes, Paris, France) was used to virtually implant an Evolut R (Medtronic) or Lotus (Boston Scientific) THV in the same position as observed at the per‐operative angio and/or postoperative MDCT images, leading to a prediction of device and aortic root deformation, potential PVL and contact pressure associated with conduction abnormalities . Finally, a drop in pressure from the ascending aorta to the coronary arteries was quantified using computational fluid dynamics OpenFOAM version 5 (OpenCFD, Bracknell, United Kingdom).…”

Section: Methodsmentioning

confidence: 99%

“…Patient specific computer simulation of transcatheter aortic valve implantation (TAVI) procedures is increasingly used in patients with tricuspid aortic valve disease in order to improve procedure outcome. These models, based on multislice computer tomography (MSCT) derived patient specific anatomy and prosthetic valve specifications, can predict paravalvular leakage (PVL), contact pressure and valve shape on three different implantation depths after implantation of the self‐expandable Medtronic Evolut R (Medtronic, Minneapolis, USA) and mechanical expanded Lotus Valve of Boston Scientific (Boston Scientific, Marlborough, USA) . This provides physicians additional insights to select the optimal valve size and implantation depth for individual patients.…”

Section: Introductionmentioning

confidence: 99%

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Insight on patient specific computer modeling of transcatheter aortic valve implantation in patients with bicuspid aortic valve disease

Brouwer

Gheorghe

Nijenhuis

et al. 2018

Cathet Cardio Intervent

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Objective: The aim of this study was to describe the early use of dedicated patient specific computer modeling in patients with bicuspid aortic valve (BAV) undergoing transcatheter aortic valve implantation (TAVI), in predicting procedure feasibility and patient related outcome.Background: Dedicated patient specific computer modeling, used for optimizing TAVI procedures, is currently validated for the prediction of contact pressure, valve morphology and paravalvular leakage (PVL). The simulation of TAVI procedures is increasingly used in patients with tricuspid aortic valve stenosis. Currently, BAV disease is considered as a relative contraindication for TAVI due to its specific anatomical characteristics.Methods: This single center study consisted of seven patients with BAV undergoing TAVI.A patient specific computer simulation was performed based on multislice computer tomography images. The model advised the best fitting prosthetic valve size or sizes and simulated this valve on different implantation depths with the corresponding presence and severity of PVL and prosthetic valve morphology. The simulation results were compared with the procedural outcomes using transesophageal echocardiography (TEE) and fluoroscopy.Results: The patient specific computer modeling predicted accurately the outcome (PVL and valve morphology) of TAVI in all cases. In one case, the TAVI procedure was unsuccessful and retrospectively not suitable for TAVI, which was correctly predicted by the model. Conclusion:The patient specific computer modeling adequately predicts feasibility and outcome of TAVI in patients with BAV disease and may extend the applicability of TAVI. Moreover, it improves decision-making and therefore individual procedural outcomes in this difficult patient population.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Insight on patient specific computer modeling of transcatheter aortic valve implantation in patients with bicuspid aortic valve disease

Brouwer

Gheorghe

Nijenhuis

et al. 2018

Cathet Cardio Intervent

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“…Patient‐specific biophysical models of cardiac behavior have proven competent in elucidating the fundamentals of cardiac (patho)physiology. Recently, computational models have been used to help clinicians diagnose, to evaluate drug effects, to gain better insight on risk‐benefit ratios, and to predict the outcome of different treatment strategies . Even though full four‐chamber heart models are the most comprehensive, the application of such models in the clinical environment is challenging because the available imaging data resolution is often insufficient to accurately segment the atrial wall, which is typically an order of magnitude thinner than the ventricular wall.…”

Section: Introductionmentioning

confidence: 99%

Kinematic boundary conditions substantially impact in silico ventricular function

Peirlinck

Sack

Backer

et al. 2018

Numer Methods Biomed Eng

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Computational cardiac mechanical models, individualized to the patient, have the potential to elucidate the fundamentals of cardiac (patho-)physiology, enable non-invasive quantification of clinically significant metrics (eg, stiffness, active contraction, work), and anticipate the potential efficacy of therapeutic cardiovascular intervention. In a clinical setting, however, the available imaging resolution is often limited, which limits cardiac models to focus on the ventricles, without including the atria, valves, and proximal arteries and veins. In such models, the absence of surrounding structures needs to be accounted for by imposing realistic kinematic boundary conditions, which, for prognostic purposes, are preferably generic and thus non-image derived. Unfortunately, the literature on cardiac models shows no consistent approach to kinematically constrain the myocardium. The impact of different approaches (eg, fully constrained base, constrained epi-ring) on the predictive capacity of cardiac mechanical models has not been thoroughly studied. For that reason, this study first gives an overview of current approaches to kinematically constrain (bi) ventricular models. Next, we developed a patient-specific in silico biventricular model that compares well with literature and in vivo recorded strains. Alternative constraints were introduced to assess the influence of commonly used mechanical boundary conditions on both the predicted global functional behavior of the in-silico heart (cavity volumes, stroke volume, ejection fraction) and local strain distributions. Meaningful differences in global functioning were found between different kinematic anchoring strategies, which brought forward the importance of selecting appropriate boundary conditions for biventricular models that, in the near future, may inform clinical intervention. However, whilst statistically significant differences were also found in local strain distributions, these differences were minor and mostly confined to the region close to the applied boundary conditions.

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“…The third study assessed whether the software can predict the occurrence of conduction abnormalities after TAVI based on the analysis of contact pressure and contact pressure area in a predefined region below the non-coronary and right coronary cusp 22. Finite-element computer simulations were performed in 112 patients who had undergone Transcatheter Aortic Valve Replacement (TAVR) with the self-expanding CoreValve/Evolut R valve (figure 4).…”

Section: Introductionmentioning

confidence: 99%

“…For further details, please see Ref. 22. LOVT, left ventricular outflow tract; TAVI, transcatheter aortic valve implantation.…”

Section: Introductionmentioning

confidence: 99%

Patient-specific computer simulation for transcatheter cardiac interventions: what a clinician needs to know

Jaegere

Rocatello

Prendergast

et al. 2019

Heart

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Patient-specific computer simulation consists of the assessment of the interaction of the device with the host based on the integration of the detailed geometric and biomechanical properties of the device and host. Hence, it allows the prediction of valve performance (efficacy) and complications (safety) and may consequently help the physician to select the valve/device that best fits the individual patient, thereby improving outcome. There is currently little awareness and information in clinical medicine on patient-specific computer simulation. In this paper, we describe the technical background and a number of illustrations to illustrate how patient-specific computer simulation may be used for catheter-based treatment planning of acquired heart disease.

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Patient-Specific Computer Simulation to Elucidate the Role of Contact Pressure in the Development of New Conduction Abnormalities After Catheter-Based Implantation of a Self-Expanding Aortic Valve

Abstract: Patient-specific computer simulations revealed that maximum contact pressure and contact pressure index are both associated with new conduction abnormalities after CoreValve/Evolut R implantation and can predict which patient will have conduction abnormalities.

Cited by 87 publications

References 25 publications

Insight on patient specific computer modeling of transcatheter aortic valve implantation in patients with bicuspid aortic valve disease

Insight on patient specific computer modeling of transcatheter aortic valve implantation in patients with bicuspid aortic valve disease

Kinematic boundary conditions substantially impact in silico ventricular function

Patient-specific computer simulation for transcatheter cardiac interventions: what a clinician needs to know

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