Bioengineering Case Study to Evaluate Complications of Adverse Anatomy of Aortic Root in Transcatheter Aortic Valve Replacement: Combining Biomechanical Modelling with CT Imaging

Spadaccio, Cristiano; Mazzocchi, Laura; Timofeva, Irina; Macron, Laurent; Cecco, Carlo N. De; Morganti, Simone; Auricchio, Ferdinando; Nappi, Francesco

doi:10.3390/bioengineering7040121

Cited by 8 publications

(27 citation statements)

References 14 publications

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“…The degree of native valve calcifications, stent geometry, and size of the patient’s annulus, alongside the physiological dynamics of blood flow, were demonstrated to affect the performance of TAVR devices [ 17 , 22 , 23 ]. In first-generation biomechanical models of CoreValve [ 11 ] and Sapien XT [ 10 ], the presence of isolated bulky annular calcifications was shown to lead to geometric alterations of the aortic annulus post-deployment.…”

Section: Discussionmentioning

confidence: 99%

“…It is important to underline that unlike the standard aortic valve replacement, which allows the complete removal of calcifications, in the percutaneous procedure the calcifications are pressed against the aortic wall. The postoperative CT scan fails to show these calcifications [ 11 , 12 ]. Prosthetic stent deformation of both self-expandable and balloon-expandable devices was noted as a consequence of these calcifications, which caused a high degree of mismatch between the native aortic root wall and the stent profile.…”

Section: Discussionmentioning

confidence: 99%

“…Studies have suggested the role of complex native calcifications of the aortic valve in the occurrence of these complications [ 7 , 8 ]. However, the computed tomography (CT) imaging modalities routinely used in the perioperative work-up for TAVR have proven unable to clearly identify all the anatomical parameters or characteristics predicting the risk of occurrence of device complications [ 11 , 12 ].…”

Section: Introductionmentioning

confidence: 99%

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CoreValve vs. Sapien 3 Transcatheter Aortic Valve Replacement: A Finite Element Analysis Study

et al. 2021

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Aim: to investigate the factors implied in the development of postoperative complications in both self-expandable and balloon-expandable transcatheter heart valves by means of finite element analysis (FEA). Materials and methods: FEA was integrated into CT scans to investigate two cases of postoperative device failure for valve thrombosis after the successful implantation of a CoreValve and a Sapien 3 valve. Data were then compared with two patients who had undergone uncomplicated transcatheter heart valve replacement (TAVR) with the same types of valves. Results: Computational biomechanical modeling showed calcifications persisting after device expansion, not visible on the CT scan. These calcifications determined geometrical distortion and elliptical deformation of the valve predisposing to hemodynamic disturbances and potential thrombosis. Increased regional stress was also identified in correspondence to the areas of distortion with the associated paravalvular leak. Conclusion: the use of FEA as an adjunct to preoperative imaging might assist patient selection and procedure planning as well as help in the detection and prevention of TAVR complications.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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CoreValve vs. Sapien 3 Transcatheter Aortic Valve Replacement: A Finite Element Analysis Study

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“…The use of the MitraClip procedure is recommended in patients with disproportionate secondary mitral regurgitation in which severe MR is coupled with nonseverely dilated left ventricular chambers [95,96]. Although this new framework is a very attractive proposal, however, it does not find unanimous consensus and requires further deep investigation involving transcatheter heart valve therapy [113][114][115][116][117][118][119][120][121][122][123][124][125][126][127].…”

Section: Discussionmentioning

confidence: 99%

Exploring the Operative Strategy for Secondary Mitral Regurgitation: A Systematic Review

Nappi

Singh

Bellomo

et al. 2021

BioMed Research International

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Background. Mitral valve disease surgery is an evolving field with multiple possible interventions. There is an increasing body of evidence regarding the optimal strategy in secondary mitral regurgitation where the pathology lies within the ventricle. We conducted a systematic review to identify the benefits and limitations of each surgical option. Methods. A systematic review of the literature was performed to identify pertinent randomized controlled trials (RCTs), propensity-matched observational series, and meta-analyses which were considered initially and followed by unmatched observational series using the MEDLINE, Ovid EMBASE, and Cochrane Library. Results. We identified 6 different strategies for treating secondary mitral valve regurgitation: mitral valve replacement, restrictive mitral annuloplasty, surgical revascularization (with and without mitral annuloplasty), subvalvular procedures (papillary muscle approximation, papillary muscle relocation, ring and string procedure), and procedures directly targeting the mitral valve (edge-to-edge repair and anterior leaflet enlargement) alongside transcatheter heart valve therapy. We also highlighted the role of left ventricular assist devices in the management of this condition. The benefits and limitations of each intervention are highlighted. Conclusion. There is currently no unanimous and shared strategy for the optimal treatment of patients with secondary IMR. The management of patients with secondary mitral regurgitation must be entrusted to a multidisciplinary Heart Team to ensure ideal intervention and patient matching for the best outcomes.

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“…Therefore, its application can lead to the development of predictive models useful for the understanding of the thrombotic process and TAVR functionality in a complex structure such as the aortic root. Mechanical stress can induce remodeling phenomena in the aortic root that can lead to changes in the morphology of the wall [59][60][61][62][63][64][65][66][67][68][69][70][71][72][73][74][75].…”

Section: 4mentioning

confidence: 99%

Percutaneous versus Surgical Intervention for Severe Aortic Valve Stenosis: A Systematic Review

Iervolino

Singh

Nappi

et al. 2021

BioMed Research International

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Aortic stenosis is a disease that is increasing in prevalence and manifests as decreased cardiac output, which if left untreated can result in heart failure and ultimately death. It is primarily a disease of the elderly who often have multiple comorbidities. The advent of transcatheter aortic valve therapies has changed the way we treat these conditions. However, long-term results of these therapies remain uncertain. Recently, there has been an increasing number of studies examining the role of both surgical aortic valve replacement and transcatheter aortic valve replacement. We therefore performed a systematic review using Ovid MEDLINE, Ovid Embase, and the Cochrane Library. Two investigators searched papers published between January 1, 2007, and to date using the following terms: “aortic valve stenosis,” “aortic valve operation,” and “transcatheter aortic valve therapy.” Both strategies in aortic stenosis treatment highlighted specific indications alongside the pitfalls such as structural valve degeneration and valve thrombosis which have a bearing on clinical outcomes. We propose some recommendations to help clinicians in the decision-making process as technological improvements make both surgical and transcatheter therapies viable options for patients with aortic stenosis. Finally, we assess the role of finite element analysis in patient selection for aortic valve replacement. THVT and AVR-S are both useful tools in the armamentarium against aortic stenosis. The decision between the two treatment strategies should be best guided by a strong robust evidence base, ideally with a long-term follow-up. This is best performed by the heart team with the patient as the center of the discussion.

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Bioengineering Case Study to Evaluate Complications of Adverse Anatomy of Aortic Root in Transcatheter Aortic Valve Replacement: Combining Biomechanical Modelling with CT Imaging

Cited by 8 publications

References 14 publications

CoreValve vs. Sapien 3 Transcatheter Aortic Valve Replacement: A Finite Element Analysis Study

CoreValve vs. Sapien 3 Transcatheter Aortic Valve Replacement: A Finite Element Analysis Study

Exploring the Operative Strategy for Secondary Mitral Regurgitation: A Systematic Review

Percutaneous versus Surgical Intervention for Severe Aortic Valve Stenosis: A Systematic Review

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