On the spectrum of transcatheter mitral valve replacement: In silico and in vitro assessment of neo-LVOT area in ViR, ViV and ViMAC

Catalano, Chiara; Cannata, Stefano; Agnese, Valentina; Gentile, Giovanni; Gandolfo, Caterina; Pasta, Salvatore

doi:10.1016/j.bprint.2023.e00285

Bioprinting

2023

DOI: 10.1016/j.bprint.2023.e00285

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On the spectrum of transcatheter mitral valve replacement: In silico and in vitro assessment of neo-LVOT area in ViR, ViV and ViMAC

Chiara Catalano

Stefano Cannata

Valentina Agnese

et al.

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Cited by 3 publications

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“…In the case of edge-to-edge mitral valve repair, simulations of the surgical procedure were compared to echocardiography, revealing that the stress in the leaflets after the edge-to-edge suture was reduced [36]. In previous studies, we demonstrated the feasibility of transcatheter mitral valve replacement in the setting of failed annuloplasty band ring [37], surgical bioprosthesis [38], and massive mitral valve calcifications [39]. In computational studies of the MitraClip, Morgan and collaborators concluded that an uneven MitraClip position led to low anterior and posterior leaflet stress with respect to the model with leaflet prolapse and no clip [40].…”

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confidence: 99%

In Silico Analysis of the MitraClip in a Realistic Human Left Heart Model

Pasta

2023

Prosthesis

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Mitral valve regurgitation is a common heart valve disorder associated with significant morbidity and mortality. Transcatheter mitral valve repair using the MitraClip device has emerged as a safe and effective alternative for patients unsuitable for conventional surgery. However, the structural and hemodynamic implications of MitraClip implantation in the left ventricle have not been extensively explored. This study aimed to assess the structural and hemodynamic performance of the MitraClip device using a high-fidelity model of the human heart, specifically focusing on a healthy mitral valve geometry. The implantation of the MitraClip device was simulated using the finite element method for structural analysis and the lattice Boltzmann method for computational flow analysis. MitraClip implantation induced geometrical changes in the mitral valve, resulting in local maxima of principal stress in the valve leaflet regions constrained by the device. Hemodynamic assessment revealed slow-moving nested helical flow near the left ventricular wall and high flow velocities in the apex regions. Vorticity analysis indicated abnormal hemodynamic conditions induced by the double-orifice area configuration of the mitral valve after MitraClip implantation. By predicting possible adverse events and complications in a patient-specific manner, computational modeling supports evidence-based decision making and enhances the overall effectiveness and safety of transcatheter mitral valve repairs.

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In Silico Analysis of the MitraClip in a Realistic Human Left Heart Model

Pasta

2023

Prosthesis

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On the Material Constitutive Behavior of the Aortic Root in Patients with Transcatheter Aortic Valve Implantation

Catalano,

Turgut,

Zahalka

et al. 2023

Cardiovasc Eng Tech

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Background Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure used to treat patients with severe aortic valve stenosis. However, there is limited knowledge on the material properties of the aortic root in TAVI patients, and this can impact the credibility of computer simulations. This study aimed to develop a non-invasive inverse approach for estimating reliable material constituents for the aortic root and calcified valve leaflets in patients undergoing TAVI. Methods The identification of material parameters is based on the simultaneous minimization of two cost functions, which define the difference between model predictions and cardiac-gated CT measurements of the aortic wall and valve orifice area. Validation of the inverse analysis output was performed comparing the numerical predictions with actual CT shapes and post-TAVI measures of implanted device diameter. Results A good agreement of the peak systolic shape of the aortic wall was found between simulations and imaging, with similarity index in the range in the range of 83.7% to 91.5% for n.20 patients. Not any statistical difference was observed between predictions and CT measures of orifice area for the stenotic aortic valve. After TAVI simulations, the measurements of SAPIEN 3 Ultra (S3) device diameter were in agreement with those from post-TAVI angio-CT imaging. A sensitivity analysis demonstrated a modest impact on the S3 diameters when altering the elastic material property of the aortic wall in the range of inverse analysis solution. Conclusions Overall, this study demonstrates the feasibility and potential benefits of using non-invasive imaging techniques and computational modeling to estimate material properties in patients undergoing TAVI.

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Computational fluid dynamics in cardiac surgery and perfusion: A review

Catalano,

Crascì,

Puleo

et al. 2024

Perfusion

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Cardiovascular diseases persist as a leading cause of mortality and morbidity, despite significant advances in diagnostic and surgical approaches. Computational Fluid Dynamics (CFD) represents a branch of fluid mechanics widely used in industrial engineering but is increasingly applied to the cardiovascular system. This review delves into the transformative potential for simulating cardiac surgery procedures and perfusion systems, providing an in-depth examination of the state-of-the-art in cardiovascular CFD modeling. The study first describes the rationale for CFD modeling and later focuses on the latest advances in heart valve surgery, transcatheter heart valve replacement, aortic aneurysms, and extracorporeal membrane oxygenation. The review underscores the role of CFD in better understanding physiopathology and its clinical relevance, as well as the profound impact of hemodynamic stimuli on patient outcomes. By integrating computational methods with advanced imaging techniques, CFD establishes a quantitative framework for understanding the intricacies of the cardiac field, providing valuable insights into disease progression and treatment strategies. As technology advances, the evolving synergy between computational simulations and clinical interventions is poised to revolutionize cardiovascular care. This collaboration sets the stage for more personalized and effective therapeutic strategies. With its potential to enhance our understanding of cardiac pathologies, CFD stands as a promising tool for improving patient outcomes in the dynamic landscape of cardiovascular medicine.

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On the spectrum of transcatheter mitral valve replacement: In silico and in vitro assessment of neo-LVOT area in ViR, ViV and ViMAC

Cited by 3 publications

References 32 publications

In Silico Analysis of the MitraClip in a Realistic Human Left Heart Model

In Silico Analysis of the MitraClip in a Realistic Human Left Heart Model

On the Material Constitutive Behavior of the Aortic Root in Patients with Transcatheter Aortic Valve Implantation

Computational fluid dynamics in cardiac surgery and perfusion: A review

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