Abstract:Transcatheter aortic valve replacement (TAVR) is a frequently used minimally invasive intervention for patient with aortic stenosis across a broad risk spectrum. While coronary artery disease (CAD) is present in approximately half of TAVR candidates, correlation of post-TAVR complications such as paravalvular leakage (PVL) or misalignment with CAD are not fully understood. For this purpose, we developed a multiscale computational framework based on a patient-specific lumped-parameter algorithm and a 3-D strong… Show more
“… 20 The magnitude of the LV load is reliant on both the LV's pressure and its volume, and an overloaded LV (greater than 1J) is connected to disproportionate contribution of pressure and volume to LV’s work. 20 , 24 As an illustration, for patient #21 ( Figure 3 ), the surplus LV load after TAVR (1.64 J) was caused by persistent high pressure in LV (e.g., LV peak pressure was 155 mmHg post-TAVR). Despite the remarkable decrease in aortic valve pressure gradient as well as modest decrease in peak LV pressure for all patients following TAVR ( Figure 6 a and c ), the LV workload failed to improve in more than half of the cases ( Figure 6 b).…”
Section: Resultsmentioning
confidence: 99%
“…It is important to quantify global and local flow, 30 , 31 as this can help detect issues which standard anatomical assessments overlook. 24 , 43 These alterations can result in thrombosis down the line ( Figure 8 ), and would have likely gone undetected if a hemodynamic evaluation had not been done. 43 Figure 8 TAVR and the challenge of reducing the risk of leaflet thrombosis and coronary plaque progression over time.…”
Section: Discussionmentioning
confidence: 99%
“…The developed framework was validated against cardiac catheterization data with a considerable inter- and intra-patient variability with a broad range of diseases in a population of forty-nine patients (with AS). 20 Moreover, some of the sub-models of the patient-specific lumped parameter algorithm have been used previously, 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 with validation against in vivo cardiac catheterization 32 , 33 in patients with vascular diseases, in vivo magnetic resonance imaging data 34 in patients with AS, and in vivo magnetic resonance imaging data 35 , 36 , 37 in patients with mixed valvular diseases and coarctation.…”
Section: Methodsmentioning
confidence: 99%
“…We developed a fluid-solid interaction and lumped parameter modeling framework to calculate 3D blood flow dynamics in all main coronary artery branches (left main coronary artery, left anterior descending [LAD], left circumflex [LCX], and right coronary artery [RCA]), aortic root, ascending aorta, sinus, and neo-sinus regions for both pre- and post-TAVR ( Figure 1 ) (See Supplemental Materials ). Our patient-specific lumped parameter model and 3D fluid-solid interaction modeling (used to compute local hemodynamics) were validated against in vivo DE data as explained in Khodaei et al 22 , 24 , 38 and Keshavarz-Motamed et al. 39 …”
“… 20 The magnitude of the LV load is reliant on both the LV's pressure and its volume, and an overloaded LV (greater than 1J) is connected to disproportionate contribution of pressure and volume to LV’s work. 20 , 24 As an illustration, for patient #21 ( Figure 3 ), the surplus LV load after TAVR (1.64 J) was caused by persistent high pressure in LV (e.g., LV peak pressure was 155 mmHg post-TAVR). Despite the remarkable decrease in aortic valve pressure gradient as well as modest decrease in peak LV pressure for all patients following TAVR ( Figure 6 a and c ), the LV workload failed to improve in more than half of the cases ( Figure 6 b).…”
Section: Resultsmentioning
confidence: 99%
“…It is important to quantify global and local flow, 30 , 31 as this can help detect issues which standard anatomical assessments overlook. 24 , 43 These alterations can result in thrombosis down the line ( Figure 8 ), and would have likely gone undetected if a hemodynamic evaluation had not been done. 43 Figure 8 TAVR and the challenge of reducing the risk of leaflet thrombosis and coronary plaque progression over time.…”
Section: Discussionmentioning
confidence: 99%
“…The developed framework was validated against cardiac catheterization data with a considerable inter- and intra-patient variability with a broad range of diseases in a population of forty-nine patients (with AS). 20 Moreover, some of the sub-models of the patient-specific lumped parameter algorithm have been used previously, 20 , 22 , 23 , 24 , 25 , 26 , 27 , 28 , 29 , 30 , 31 with validation against in vivo cardiac catheterization 32 , 33 in patients with vascular diseases, in vivo magnetic resonance imaging data 34 in patients with AS, and in vivo magnetic resonance imaging data 35 , 36 , 37 in patients with mixed valvular diseases and coarctation.…”
Section: Methodsmentioning
confidence: 99%
“…We developed a fluid-solid interaction and lumped parameter modeling framework to calculate 3D blood flow dynamics in all main coronary artery branches (left main coronary artery, left anterior descending [LAD], left circumflex [LCX], and right coronary artery [RCA]), aortic root, ascending aorta, sinus, and neo-sinus regions for both pre- and post-TAVR ( Figure 1 ) (See Supplemental Materials ). Our patient-specific lumped parameter model and 3D fluid-solid interaction modeling (used to compute local hemodynamics) were validated against in vivo DE data as explained in Khodaei et al 22 , 24 , 38 and Keshavarz-Motamed et al. 39 …”
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