Abstract 12899: A Patient-Specific Fluid-Structure Interaction-Based Approach to Improve Surgical Predictability in Bicuspid Aortic Valve Patients

Abstract

Introduction: BAV is the most common congenital heart defect affecting ~1.4% of the population. It also brings with it an increased risk of aortopathy, including coarctation, aneurysm, dissection, and accelerated calcification with either stenosis or aortic insufficiency. Quantifying BAV function, altered blood flow, and corresponding hemodynamic forces and their impact on accelerated BAV deterioration improves BAV diagnosis. Predicting how these parameters improve post-interventions may improve surgical predictability and long-term outcome. Methods: A patient-specific modeling protocol based on MRI-based patient data and strongly coupled fluid-structure interaction (FSI) technique was developed to evaluate BAV. Flow via left ventricle, BAV, ascending and descending aorta (Fig A-B) was simulated to obtain biomechanical insights near valve vicinity and study its effects downstream. Diseased anatomy was simulated, and biomechanics compared with virtual interventions that included 1) surgical aortic valve replacement (SAVR), 2) valve sparing root replacement (VSRR) with a sinus graft, and 3) VSRR without sinus graft (Fig C). Results: Our model predictions showed that viscous dissipation (or energy loss) was the greatest in the diseased BAV indicating a high energy loss that substantially reduced post-virtual interventions. Specifically, energy loss reduced by 2.55-, 1.65-, 2.52- folds for SAVR, VSRR-sinus, and VSRR+sinus respectively at peak-systole (Fig. E-H). Interestingly, while SAVR produced the largest orifice area (OA), OA of BAV marginally reduced post VSRR during peak-systole (Fig. I) Conclusions: These studies provide insights into BAV dynamics and may help determine the optimal interventions for a patient. These insights may help improve diagnosis and surgical predictability, optimize treatment, and help with clinical decision making for BAV patients at risk.