Stent and leaflet stresses in a 26-mm first-generation balloon-expandable transcatheter aortic valve

Xuan, Yue; Krishnan, Kapil; Ye, Jian; Dvir, Danny; Guccione, Julius M.; Ge, Liang; Tseng, Elaine E.

doi:10.1016/j.jtcvs.2016.12.016

Cited by 29 publications

(50 citation statements)

References 27 publications

(35 reference statements)

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“…Finally, the application of Finite Element Analysis research to biological structures may be of value [21,27,39,40]. FEA investigation uses the geometric algorithmic prediction to calculate the stress and strain coefficients of the complex.…”

Section: Dynamic Of Aortic Root and Persistent Bulky Calcification: Still Relevant?mentioning

confidence: 99%

A Finite Element Analysis Study from 3D CT to Predict Transcatheter Heart Valve Thrombosis

et al. 2020

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Background: Transcatheter aortic valve replacement has proved its safety and effectiveness in intermediate- to high-risk and inoperable patients with severe aortic stenosis. However, despite current guideline recommendations, the use of transcatheter aortic valve replacement (TAVR) to treat severe aortic valve stenosis caused by degenerative leaflet thickening and calcification has not been widely adopted in low-risk patients. This reluctance among both cardiac surgeons and cardiologists could be due to concerns regarding clinical and subclinical valve thrombosis. Stent performance alongside increased aortic root and leaflet stresses in surgical bioprostheses has been correlated with complications such as thrombosis, migration and structural valve degeneration. Materials and Methods: Self-expandable catheter-based aortic valve replacement (Medtronic, Minneapolis, MN, USA), which was received by patients who developed transcatheter heart valve thrombosis, was investigated using high-resolution biomodelling from computed tomography scanning. Calcific blocks were extracted from a 250 CT multi-slice image for precise three-dimensional geometry image reconstruction of the root and leaflets. Results: Distortion of the stent was observed with incomplete cranial and caudal expansion of the device. The incomplete deployment of the stent was evident in the presence of uncrushed refractory bulky calcifications. This resulted in incomplete alignment of the device within the aortic root and potential dislodgment. Conclusion: A Finite Element Analysis (FEA) investigation can anticipate the presence of calcified refractory blocks, the deformation of the prosthetic stent and the development of paravalvular orifice, and it may prevent subclinical and clinical TAVR thrombosis. Here we clearly demonstrate that using exact geometry from high-resolution CT scans in association with FEA allows detection of persistent bulky calcifications that may contribute to thrombus formation after TAVR procedure.

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Section: Dynamic Of Aortic Root and Persistent Bulky Calcification: Still Relevant?mentioning

confidence: 99%

A Finite Element Analysis Study from 3D CT to Predict Transcatheter Heart Valve Thrombosis

et al. 2020

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“…However, their study was limited by the small number of patients and lack of data regarding the influences of asymmetry on TAV leaflet stresses. The study by Xuan et al provided more emphatic evidence because it showed that peak stresses for both the stent and leaflets of a 26mm SAPIEN™ Transcatheter Heart Valve were present at commissural tips where the leaflets were attached, which is consistent with, albeit not conclusive of, a risk of leaflet degeneration [27].…”

Section: Resultsmentioning

confidence: 99%

“…Transcatheter Heart Valve Replacement: The Successes Achieved Are Not Enough to Disguise the Concern of Thrombosis and Structural Valve Deterioration principal stress for bovine and porcine pericardial leaflets was 915.62 kPa and 1565.80 kPa, respectively, fin tThe ffuflfly floaded posfitfion [27,28]. The measurement of leaflet stresses showed higher deformation and peak stresses along the leaflet-stent attachment along the commissures.…”

Section: Short Commentarymentioning

confidence: 99%

Brain Dopamine Transporter Availability is Associated with Response Time (RT) Variability in Adults with ADHD

Chuang¹,

Yeh²,

Huang³

et al. 2017

Neuropsychiatry

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This article summarizes the current research on the benefits of using the transfemoral approach for percutaneous aortic valve implant and the transaortic valve replacement as an operation for severe aortic valve stenosis. Based on the available evidence, the authors provide recommendations for the use of the catheter aortic implantation in intermediate/high risk patients undergoing mechanical operation. Further studies are needed before extensive use of the catheter-based aortic valve procedure in younger patients at lower risk.

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“…Such changes in THV configuration can affect leaflet stresses. Prior THV biomechanical studies have suggested that greater leaflet stresses accelerate THV degeneration and limit long term durability [13][14][15][16][17] . There is no method to directly measure leaflet stresses, thus computational methods such as finite element analysis (FEA) are valuable for providing such data, which assess failure modes.…”

Section: Introductionmentioning

confidence: 99%

“…Accurate finite element (FE) models require precise 3D geometry in a zerostress state, material properties, and physiologic loading conditions. Our previous FEA studies have determined THV leaflet stresses on specific sizes of first- 16 , second- 17 , and third-generation 15 SAPIEN, SAPIEN XT, and SAPIEN 3 valves (Edwards Lifsciences Inc., Irvine, CA, USA) under quasi-static loading conditions based on micro-CT images. However, the impact of THV size on THV leaflet stresses is unknown.…”

Section: Introductionmentioning

confidence: 99%

Impact of transcatheter aortic valve size on leaflet stresses: implications for durability and optimal grey zone sizing

et al. 2020

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Aims: As indications for transcatheter aortic valve replacement (TAVR) continue to expand towards younger and lower-risk patients, durability becomes an increasingly important question. Durability decreases as leaflet stresses increase, but the impact of transcatheter heart valve (THV) size on stress is unknown. Patient annulus sizes can fall within "grey zones" between 2 TAVR sizes. Our aim was to examine the impact of balloon-expandable THV size on leaflet stresses.Methods and results: SAPIEN XT 23 mm, 26 mm, and 29 mm size valves underwent micro-computed tomography scanning to create THV computational models then loaded to systemic pressure using finite element software. THV leaflet maximum principal stresses were 1.69 MPa (23 mm), 1.70 MPa (26 mm), and 2.12 MPa (29 mm) at mean arterial pressure. For intermediate annulus sizes, undersizing the larger THVs yielded lower leaflet stresses than oversizing the smaller THVs.Conclusions: Increasing THV size yielded greater leaflet maximum principal stresses, which could suggest a relationship between THV size and long-term durability. For annulus "grey zones" sizes, undersizing the larger THV resulted in lower leaflet stresses than oversizing the smaller THV. These results may influence optimal device sizing, as THV durability remains an important, unanswered question.

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Stent and leaflet stresses in a 26-mm first-generation balloon-expandable transcatheter aortic valve

Cited by 29 publications

References 27 publications

A Finite Element Analysis Study from 3D CT to Predict Transcatheter Heart Valve Thrombosis

A Finite Element Analysis Study from 3D CT to Predict Transcatheter Heart Valve Thrombosis

Brain Dopamine Transporter Availability is Associated with Response Time (RT) Variability in Adults with ADHD

Impact of transcatheter aortic valve size on leaflet stresses: implications for durability and optimal grey zone sizing

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