Numerical simulation of transcatheter mitral valve replacement: The dynamic implication of LVOT obstruction in the valve-in-ring case

Pasta, Salvatore; Catalano, Chiara; Cannata, Stefano; Guccione, Julius M.; Gandolfo, Caterina

doi:10.1016/j.jbiomech.2022.111337

Cited by 11 publications

(9 citation statements)

References 26 publications

(33 reference statements)

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“…Imaging remains crucial for understanding the proper device size to be implanted, as the TricValve system tolerates a landing zone ≤35 mm and a suboptimal device size might result in device embolization. In this study, we assessed structural indicators usually seen in computational studies of transcatheter aortic and mitral valve implantation to quantify the biomechanical anchoring performance of the TricValve system ( Finotello et al, 2017 ; Pasta et al, 2020a ; Pasta et al, 2020b ; Nappi et al, 2021 ; Pasta et al, 2022 ). The lower the device migration and leakage is, the higher the wall rupture.…”

Section: Discussionmentioning

confidence: 99%

Biomechanical performance of the Bicaval Transcatheter System for the treatment of severe tricuspid regurgitation

Crascì,

Cannata,

Gentile

et al. 2023

Front. Bioeng. Biotechnol.

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Introduction: Tricuspid regurgitation (TR) is a relatively common valvular disease, which can result from structural abnormalities of any anatomic part of the tricuspid valve. Severe TR is linked to congestive heart failure and hemodynamic impairment, resulting in high mortality when repaired by elective surgery. This study was undertaken to quantify the structural and hemodynamic performance of the novel Transcatheter Bicaval Valves System (TricValve) percutaneously implanted in the superior vena cava (SVC) and inferior vena cava (IVC) of two patients with severe TR and venous congestion.Methods: After developing the SVC and IVC device models, the contact pressure exerted on the vena cava wall was obtained by computational analysis. Both smoothed-particle hydrodynamics (SPH) and computational fluid dynamics were carried out to quantify caval reflux in the right atrium and the pressure field of pre- and post-TricValve scenarios, respectively.Results: Analysis of contact pressure highlighted the main anchoring area of the SVC device occurring near the SVC device belly, while the IVC device exerted pronounced forces in the device’s proximal and distal parts. SPH-related flow velocities revealed the absence of caval reflux, and a decrease in time-averaged pressure was observed near the SVC and IVC after TricValve implantation.Discussion: Findings demonstrated the potential of computational tools for enhancing our understanding of the biomechanical performance of structural tricuspid valve interventions and improving the way we design next-generation transcatheter therapies to treat the tricuspid valve with heterotopic caval valve implantation.

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Section: Discussionmentioning

confidence: 99%

Biomechanical performance of the Bicaval Transcatheter System for the treatment of severe tricuspid regurgitation

Crascì,

Cannata,

Gentile

et al. 2023

Front. Bioeng. Biotechnol.

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“…A dynamic high-fidelity Multiphysics model of a four-chamber adult male human heart ( Figure 1 ) (Baillargeon et al 2014), developed under the SIMULIA Living Heart Project (Dassault Systèmes, SIMULIA Corp.) has previously been used to study various cardiovascular diseases (Wisneski et al 2020; St Pierre, Peirlinck, and Kuhl 2022) including heart failure (Genet et al 2016; Costabal, Choy, et al 2019), arrhythmia (Sahli Costabal, Yao, and Kuhl 2018), effects of drug on treating these diseases (Costabal, Matsuno, et al 2019), and performance analysis of several cardiovascular procedures including TAVR (Ghosh et al 2020b), mitral valve repair (Galili, White Zeira, and Marom 2022; Heidari et al 2022; Pasta et al 2022), and left ventricular assistance device (Pasta et al 2022). In this study, this digital twin of the human heart was used to explore the interaction between the TAVR prosthesis and the conduction fibers both during the TAVR procedure and across three cardiac cycles subsequent to the procedure, in order to gain deeper insights into the mechanisms underlying the development of new conduction abnormalities at varying implantation depths and in the presence of pre-existing CCAs.…”

Section: Introductionmentioning

confidence: 99%

Assessing Post-TAVR Cardiac Conduction Abnormalities Risk Using a Digital Twin of a Beating Heart

Reza,

Kovarovic,

Bluestein

2024

Preprint

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Transcatheter aortic valve replacement (TAVR) has rapidly displaced surgical aortic valve replacement (SAVR). However, certain post-TAVR complications persist, with cardiac conduction abnormalities (CCA) being one of the major ones. The elevated pressure exerted by the TAVR stent onto the conduction fibers situated between the aortic annulus and the His bundle, in proximity to the atrioventricular (AV) node, may disrupt the cardiac conduction leading to the emergence of CCA. In his study, an in-silico framework was developed to assess the CCA risk, incorporating the effect of a dynamic beating heart and pre-procedural parameters such as implantation depth and preexisting cardiac asynchrony in the new onset of post-TAVR CCA. A self-expandable TAVR device deployment was simulated inside an electro-mechanically coupled beating heart model in five patient scenarios, including three implantation depths, and two preexisting cardiac asynchronies: (i) a right bundle branch block (RBBB) and (ii) a left bundle branch block (LBBB). Subsequently, several biomechanical parameters were analyzed to assess the post-TAVR CCA risk. The results manifested a lower cumulative contact pressure on the conduction fibers following TAVR for aortic deployment (0.018 MPa) compared to baseline (0.29 MPa) and ventricular deployment (0.52 MPa). Notably, the preexisting RBBB demonstrated a higher cumulative contact pressure (0.34 MPa) compared to the baseline and preexisting LBBB (0.25 MPa). Deeper implantation and preexisting RBBB cause higher stresses and contact pressure on the conduction fibers leading to an increased risk of post-TAVR CCA. Conversely, implantation above the MS landmark and preexisting LBBB reduces the risk.

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“…Yet, these techniques offer the opportunity to test several anatomies and device configurations, as well as investigate the effect of physiological alterations, for example, in haemodynamics and contractility, while overcoming in vivo experimental challenges [20]. In the last few years, models have been developed to test the interaction between cardiac implanted devices and the beating heart [21][22][23][24]. These studies primarily involved the evaluation of various stents made from different materials and devices aimed at valvular diseases.…”

Section: Introductionmentioning

confidence: 99%

A numerical study of a left ventricular expander for heart failure with preserved ejection fraction

Weissmann,

Benoliel,

Yap

et al. 2023

R. Soc. open sci.

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Increased cardiac stiffness hinders proper left ventricular (LV) expansion, resulting in decreased volume and diastolic dysfunction. LV expanders are spring-like devices designed to improve diastolic function by facilitating mechanical outward expansion. Implantations in animals and humans have shown promising results, yet further evaluation is needed to assess a range of functions and the risk of use. In this computational study, the effectiveness and potential use of a generic LV expander were assessed by using previously generated finite-element models of induced heart failure with preserved ejection fraction (HFpEF). Following implantation, the treated models were compared to the corresponding untreated and healthy pre-induction models. The influence of device orientation and its material properties was also examined. Our results demonstrated a reduction in LV pressure and a volumetric improvement. Computed LV stresses have shown no gross irregularities. The device contributed to stress elevation during diastole while having a minor effect during systole, supporting a basic safety profile. This is the first study to use numerical analysis to assess LV expanders' performance on different HFpEF phenotypes. Improvement in heart function was demonstrated in both subjects, suggesting its potential use in various HFpEF manifestations, yet customization and optimal deployment are essential to improve heart performance.

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Numerical simulation of transcatheter mitral valve replacement: The dynamic implication of LVOT obstruction in the valve-in-ring case

Cited by 11 publications

References 26 publications

Biomechanical performance of the Bicaval Transcatheter System for the treatment of severe tricuspid regurgitation

Biomechanical performance of the Bicaval Transcatheter System for the treatment of severe tricuspid regurgitation

Assessing Post-TAVR Cardiac Conduction Abnormalities Risk Using a Digital Twin of a Beating Heart

A numerical study of a left ventricular expander for heart failure with preserved ejection fraction

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