No abstract

Objectives:We investigated the impact of (transcatheter heart valve) THV expansion at the level of the native annulus and implant depth on valve performance and neo-sinus flow stasis.Background: Flow stasis in the neo-sinus is one of the identified risk factors of THV thrombosis. Methods: A 29 mm CoreValve and 26 mm SAPIEN 3 were deployed under different expansions (CoreValve, SAPIEN 3) and implant depths (CoreValve) within a patientderived aortic root in a pulse duplicator. Fluorescent dye was injected during diastole into the neo-sinus and imaged over 20 cardiac cycles. Washout times were computed as a measure of flow stasis for each deployment.Results: The 10% CoreValve under-expansion improved neo-sinus washout over full expansion by 8% (p < .001), and higher CoreValve implant depth improved neo-sinus washout (p < .001). The 10% SAPIEN 3 under-expansion improved neo-sinus washout by 23% (p < .001). Under-expansion of both valve types caused higher pressure gradients and smaller effective orifice areas than full expansion.Conclusions: Neo-sinus flow stasis is influenced by THV expansion and implant depth (CoreValve). The 10% valve under-deployment (oversizing) may facilitate reduced flow stasis in the neo-sinus with minimal increase in pressure gradients. This strategy may be helpful for patient anatomies, which are in-between transcatheter valve sizes. K E Y W O R D S aortic valve disease, aortic valve disease, percutaneous intervention, transcatheter valve implantation

No abstract

No abstract

Purpose The study aimed to characterize the geometry of the aortic root pre‐ and post‐transcatheter aortic valve replacement (TAVR) and investigate differences in pre‐ and post‐TAVR anatomy. Background A greater understanding of how aortic root geometry changes after TAVR is needed to facilitate further investigation into the hemodynamic profiles of the post‐TAVR aortic root. Methods Anatomical measurements were conducted on de‐identified, retrospective post‐TAVR 4DCT scans of 109 patients with aortic stenosis obtained from the RESOLVE study. The diameter of the aortic root was measured at the level of the annulus, left ventricular outflow tract (LVOT), sinus of Valsalva, sinotubular junction (STJ) and ascending aorta. The heights of the STJ and coronary arteries were also measured. Results All aortic root dimensions were normally distributed across the cohort and changed significantly between pre‐ and post‐TAVR conditions (P < 0.01). Post‐TAVR dimensions changed significantly from peak systole to end diastole (P < 0.01). Regression models were obtained for all aortic root dimensions in terms of annulus diameter with excellent coefficient of determination (R2 > 0.95, P < 0.001). Conclusions There are significant differences between pre‐ and post‐TAVR as well as peak systolic and end diastolic aortic root anatomy. Appropriate anatomical dimensions should be selected for benchtop testing as the geometry varies greatly throughout the cardiac cycle.

No abstract

No abstract

No abstract