Computed tomography predictors of structural valve degeneration in patients undergoing transcatheter aortic valve implantation with balloon-expandable prostheses

Guglielmo, Marco; Fusini, Laura; Muratori, Manuela; Tamborini, Gloria; Mantegazza, Valentina; Andreini, Daniele; Annoni, Andrea; Babbaro, Mario; Baggiano, Andrea; Conte, Edoardo; Carriero, Serena; Formenti, Alberto; Guaricci, Andrea Igoren; Mancini, Elisabetta; Mollace, Rocco; Muscogiuri, Giuseppe; Mushtaq, Saima; Ricci, Francesca; Rossi, Alexia; Scafuri, Stefano; Alushi, Brunilda; Cau, Claudio; Cau, Riccardo; Cesarano, Margherita; Saba, Luca; Rabbat, Mark; Pepi, Mauro

doi:10.1007/s00330-022-08747-x

Cited by 7 publications

(11 citation statements)

References 36 publications

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“…Relevant gender effects have been shown in arterial and valvular calcification as well as in structural aortic valve graft degeneration. 22,23 SOD3 E124D animals in our study showed significantly decreased total SOD activity in the blood serum, which A and C) represent 25% and 75% intervals, respectively, with whiskers representing minimum and maximum values. Ao.asc., ascending aorta; AoC-AI, insufficiency of the aortic conduit valve; pre, directly before AoC implantation; RVTI, ratio of velocity time integrals; SOD3 (−) , rats with superoxide dismutase-3 deficiency.…”

Section: Oxidative Stress Animal Modelmentioning

confidence: 51%

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Degeneration of biological heart valve grafts in a rat model of superoxide dismutase‐3 deficiency

et al. 2022

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While oxidative stress is known as key element in the pathogenesis of atherosclerosis and calcific aortic valve disease, its role in the degeneration of biological cardiovascular grafts has not been clarified yet. Therefore, the present study aimed to examine the impact of oxidative stress on the degeneration of biological cardiovascular allografts in a standardized chronic implantation model realized in rats exhibiting superoxide dismutase 3 deficiency (SOD3(−)). Rats with SOD3 loss‐of‐function mutation (n = 24) underwent infrarenal implantation of cryopreserved valved aortic conduits, while SOD3‐competent recipients served as controls (n = 28). After a follow‐up period of 4 or 12 weeks, comparative analyses addressed degenerative processes, hemodynamics, and evaluation of the oxidative stress model. SOD3(−) rats presented decreased circulating SOD activity (p = .0079). After 12 weeks, 58% of the implant valves in SOD3(−) rats showed regurgitation (vs. 31% in controls, p = .2377). Intima hyperplasia and chondro‐osteogenic transformation contributed to progressive graft calcification (p = .0024). At 12 weeks, hydroxyapatite deposition (p = .0198) and the gene expression of runt‐related transcription factor‐2 (Runx2) (p = .0093) were significantly enhanced in group SOD3(−). This study provides the first in vivo evidence that impaired systemic antioxidant activity contributes to biological cardiovascular graft degeneration.

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Section: Oxidative Stress Animal Modelmentioning

confidence: 51%

“…Only male rats have been included in our study to avoid potential effects of the female hormone cycle on graft degeneration, such as estrogen‐dependent protection from cardiovascular calcification. Relevant gender effects have been shown in arterial and valvular calcification as well as in structural aortic valve graft degeneration 22,23 …”

Section: Discussionmentioning

confidence: 99%

Degeneration of biological heart valve grafts in a rat model of superoxide dismutase‐3 deficiency

et al. 2022

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“…to the size of the prosthesis is one of the factors that may lead to SVD, as formulated in the CAVEAT study. 13 As mentioned in Section 2.2, the same SAPIEN XT prosthesis is implanted in all patients, thus the SLC has the same dimension in all cases. However, its positioning in the orifice plane is affected by the patient-specific distribution of pre-implantation calcium deposits, as described in Section 2.2 -Step 3.…”

Section: Reconstruction Procedure: Results and Discussionmentioning

confidence: 99%

“…Recent clinical studies have investigated the onset of SVD: a 5-year follow-up analysis has identified some possible patient-related factors such as gender, body surface area, and native annulus diameter, 10 and other studies conjectured that the cause is to be looked for in alterations in the flow-induced stress on the prosthesis. 12,13 However, nowadays the long-term assessment of TAVI has two strong limits: first, it is a relatively new technology, therefore little follow-up data is available after 10-15 years; second, the available data regards older generation devices implanted on elderly patients, usually presenting additional comorbidities and having a limited life expectancy. 14 In this respect, computational analysis can help providing insight on TAVI function and limitations, as well as allow the study of actual and potential scenarios, in order to support the clinician's decisions in the pre-intervention design phase and in the post-intervention timing of follow-up.…”

Section: Introductionmentioning

confidence: 99%

“…Since many of the aforementioned complications manifest only years after the implantation, anticipating their onset would help to set up preventive measures to avoid or reduce their negative effects. Recent clinical studies have investigated the onset of SVD: a 5‐year follow‐up analysis has identified some possible patient‐related factors such as gender, body surface area, and native annulus diameter, 10 and other studies conjectured that the cause is to be looked for in alterations in the flow‐induced stress on the prosthesis 12,13 . However, nowadays the long‐term assessment of TAVI has two strong limits: first, it is a relatively new technology, therefore little follow‐up data is available after 10–15 years; second, the available data regards older generation devices implanted on elderly patients, usually presenting additional comorbidities and having a limited life expectancy 14 …”

Section: Introductionmentioning

confidence: 99%

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Fluid‐structure interaction analysis of transcatheter aortic valve implantation

Fumagalli

Polidori

Renzi

et al. 2023

Numer Methods Biomed Eng

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Transcatheter aortic valve implantation (TAVI) is a minimally invasive intervention for the treatment of severe aortic valve stenosis. The main cause of failure is the structural deterioration of the implanted prosthetic leaflets, possibly inducing a valvular re‐stenosis 5–10 years after the implantation. Based solely on pre‐implantation data, the aim of this work is to identify fluid‐dynamics and structural indices that may predict the possible valvular deterioration, in order to assist the clinicians in the decision‐making phase and in the intervention design. Patient‐specific, pre‐implantation geometries of the aortic root, the ascending aorta, and the native valvular calcifications were reconstructed from computed tomography images. The stent of the prosthesis was modeled as a hollow cylinder and virtually implanted in the reconstructed domain. The fluid‐structure interaction between the blood flow, the stent, and the residual native tissue surrounding the prosthesis was simulated by a computational solver with suitable boundary conditions. Hemodynamical and structural indicators were analyzed for five different patients that underwent TAVI – three with prosthetic valve degeneration and two without degeneration – and the comparison of the results showed a correlation between the leaflets' structural degeneration and the wall shear stress distribution on the proximal aortic wall. This investigation represents a first step towards computational predictive analysis of TAVI degeneration, based on pre‐implantation data and without requiring additional peri‐operative or follow‐up information. Indeed, being able to identify patients more likely to experience degeneration after TAVI may help to schedule a patient‐specific timing of follow‐up.

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Aortic Stenosis and Amyloidosis: Role of MRI and CT in the Diagnosis of a Sneaky Association

Costantini,

Ostillio,

Groenhoff

et al. 2023

Curr Radiol Rep

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Purpose of the Review In this narrative review, we focus on the latest updates on CA–AS diagnosis, the implementation of CMR, and CT in the diagnostic algorithm and their future prospectives. Recent Findings Aortic stenosis (AS) is the most common valvular heart disease (VHD) worldwide. In recent years, the association between Cardiac amyloidosis (CA) and AS has emerged as a not uncommon and sneaky association. Trans-thyretin (TTR) and immunoglobulin light chain (AL) are the two most common different types of misfolded amyloid proteins infiltrating the heart. AS–CA shares some anatomical features with CA, but the association leads to worse outcome. Nearly 30% of patients undergoing TAVR suffers from CA. Differentiating CA–AS from lone AS is of great importance to tailorize pharmaceutical therapy and/or surgery. Nowadays, bone scintigraphy and urine/serum analyses are crucial to assess which type of amyloid excess there is, but to represent anatomical changes of the myocardium cardiac magnetic resonance (CMR) and computed tomography cardiac angiography (CTCA), they are the best non-invasive tools. Moreover, extracellular expansion can be quantified via CMR, but new promising studies assessing extracellular volume (ECV) via CT are emerging. Furthermore, AS–CA is a sneaky pathology afflicting elderly patients. Seen the comorbidities of the typical patient, Transcatheter Aortic Valve Replacement (TAVR) should be the indicated procedure. CT is the best imaging modality for TAVR planning with its excellent anatomical resolution. Summary CMR and CT could be integrated in the CA algorithm. Both can assess myocardium anatomical changes. Moreover, ECV is a precious tool to suggest the presence of amyloid in the myocardium.

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Computed tomography predictors of structural valve degeneration in patients undergoing transcatheter aortic valve implantation with balloon-expandable prostheses

Cited by 7 publications

References 36 publications

Degeneration of biological heart valve grafts in a rat model of superoxide dismutase‐3 deficiency

Degeneration of biological heart valve grafts in a rat model of superoxide dismutase‐3 deficiency

Fluid‐structure interaction analysis of transcatheter aortic valve implantation

Aortic Stenosis and Amyloidosis: Role of MRI and CT in the Diagnosis of a Sneaky Association

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