Complementary Role of the Computed Biomodelling through Finite Element Analysis and Computed Tomography for Diagnosis of Transcatheter Heart Valve Thrombosis

Nappi, Francesco; Mazzocchi, Laura; Singh, Sanjeet; Morganti, Simone; Sablayrolles, Jean‐Louis; Acar, Christophe; Auricchio, Ferdinando

doi:10.1155/2018/1346308

Cited by 10 publications

(47 citation statements)

References 55 publications

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“…The performance of the percutaneous aortic valve procedure is affected by the degree of native valve calcifications, stent deformation, the size of the patient's annulus, and a physiological dynamic of blood [26].…”

Section: Dynamic Of Aortic Root and Persistent Bulky Calcification: Still Relevant?mentioning

confidence: 99%

A Finite Element Analysis Study from 3D CT to Predict Transcatheter Heart Valve Thrombosis

et al. 2020

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Background: Transcatheter aortic valve replacement has proved its safety and effectiveness in intermediate- to high-risk and inoperable patients with severe aortic stenosis. However, despite current guideline recommendations, the use of transcatheter aortic valve replacement (TAVR) to treat severe aortic valve stenosis caused by degenerative leaflet thickening and calcification has not been widely adopted in low-risk patients. This reluctance among both cardiac surgeons and cardiologists could be due to concerns regarding clinical and subclinical valve thrombosis. Stent performance alongside increased aortic root and leaflet stresses in surgical bioprostheses has been correlated with complications such as thrombosis, migration and structural valve degeneration. Materials and Methods: Self-expandable catheter-based aortic valve replacement (Medtronic, Minneapolis, MN, USA), which was received by patients who developed transcatheter heart valve thrombosis, was investigated using high-resolution biomodelling from computed tomography scanning. Calcific blocks were extracted from a 250 CT multi-slice image for precise three-dimensional geometry image reconstruction of the root and leaflets. Results: Distortion of the stent was observed with incomplete cranial and caudal expansion of the device. The incomplete deployment of the stent was evident in the presence of uncrushed refractory bulky calcifications. This resulted in incomplete alignment of the device within the aortic root and potential dislodgment. Conclusion: A Finite Element Analysis (FEA) investigation can anticipate the presence of calcified refractory blocks, the deformation of the prosthetic stent and the development of paravalvular orifice, and it may prevent subclinical and clinical TAVR thrombosis. Here we clearly demonstrate that using exact geometry from high-resolution CT scans in association with FEA allows detection of persistent bulky calcifications that may contribute to thrombus formation after TAVR procedure.

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Section: Dynamic Of Aortic Root and Persistent Bulky Calcification: Still Relevant?mentioning

confidence: 99%

A Finite Element Analysis Study from 3D CT to Predict Transcatheter Heart Valve Thrombosis

et al. 2020

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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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“…One of the concerns regarding TAVR includes the degree of native valve calcification and its location, stent deformation, and the size of the patient's annulus. Moreover, physiological blood dynamics is a domain that has not yet been fully explored [54].…”

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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Complementary Role of the Computed Biomodelling through Finite Element Analysis and Computed Tomography for Diagnosis of Transcatheter Heart Valve Thrombosis

Cited by 10 publications

References 55 publications

A Finite Element Analysis Study from 3D CT to Predict Transcatheter Heart Valve Thrombosis

A Finite Element Analysis Study from 3D CT to Predict Transcatheter Heart Valve Thrombosis

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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