Development of an In Vitro Model to Characterize the Effects of Transcatheter Aortic Valve on Coronary Artery Flow

Abstract

Impairment of coronary artery flow, in either acute or chronic conditions, is a severe complication of transcatheter aortic valve (TAV) implantation, which can arise due to improper TAV positioning. However, little work has been done to quantify the effects of the TAV positioning on the coronary flow. In this study, a realistic in vitro model of coronary artery flow was developed and used to investigate the impact of TAV deployed orientations on coronary flow. The coronary hemodynamics was first replicated mathematically using a lumped parameter model with time-varying myocardial resistance. Based on the analytical model, two stepper motor controlled stopcock valves were integrated in a left heart simulator to represent the variable myocardial resistance in the experimental setup. The coronary flow and pressure waveforms obtained from the in vitro system were consistent with published data. With a TAV deployed in different orientations, the measured results demonstrated that TAV orientation does not have a significant impact on the coronary flow. The developed in vitro model can be further utilized to simulate coronary flow under various pathological conditions.

Numerical Parametric Study of Paravalvular Leak Following a Transcatheter Aortic Valve Deployment Into a Patient-Specific Aortic Root

“…2). Lumped parameter model established previously [39] was implemented at the coronary arteries to couple the local pressure with the flow rate. This model has been validated [39] to be able to capture physiological coronary blood flows.…”

Mock circulatory loop applications for testing cardiovascular assist devices and in vitro studies

“…Since coronary artery disease accounts for a large proportion of cardiovascular disease, many scholars have incorporated coronary circulation in the MCL ( Geven et al, 2004 ; Koenig et al, 2004 ; Pantalos et al, 2004 ; Park et al, 2006 ; Kaebnick et al, 2007 ; Park et al, 2007 ; Zannoli et al, 2009 ; Schampaert et al, 2011 ; Giridharan et al, 2012 ; Schampaert et al, 2014 ; Madukauwa-David et al, 2020 ). The flow characteristics of coronary circulation can be realized by means of the stepping motor cooperating with the valve ( Calderan et al, 2016 ), the parallel pipeline with the solenoid valve ( Rezaienia et al, 2017 ), PID control ( Gregory et al, 2020 ), the piston pump ( Madukauwa-David et al, 2020 ), etc. MCL with coronary circulation can provide trainings for coronary surgeries ( Park et al, 2006 ; Park et al, 2007 ) as well as investigate the interaction between medical devices and coronary arteries ( Calderan et al, 2016 ; Madukauwa-David et al, 2020 ).…”

Hemodynamics inside the neo‐ and native sinus after TAVR: Effects of implant depth and cardiac output on flow field and coronary flow

“…Usually, coronary flow is highest in diastole (left coronary artery). The risk of coronary obstruction increases with suboptimal THV positioning 8,9 …”

“…6 Latter is a rare (<1%), but life-threatening complication. 7 Coronary obstruction can occur when the THV prosthesis pushes the native aortic valve leaflets toward the coronary ostia 7,8 potentially interfering with coronary perfusion. Usually, coronary flow is highest in diastole (left coronary artery).…”

“…The risk of coronary obstruction increases with suboptimal THV positioning. 8,9 Even for experienced operators, valve positioning remains a critical step during the procedure. Excessively high implantation of the prosthesis can lead to obstruction of the coronary ostia with a potential need for percutaneous coronary intervention 6,7,10 and may increase the risk of valve dislodgment postimplantation.…”