Valve Type, Size, and Deployment Location Affect Hemodynamics in an In Vitro Valve-in-Valve Model

Midha, Prem A.; Raghav, Vrishank; Condado, José F.; Okafor, Ikechukwu; Lerakis, Stamatios; Thourani, Vinod H.; Babaliaros, Vasilis; Yoganathan, Ajit P.

doi:10.1016/j.jcin.2016.05.030

Cited by 72 publications

(54 citation statements)

References 25 publications

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“…A higher implantation depth was also associated with reduced pressure gradients and greater EOA in the CoreValve regardless of annular expansion. This finding, which is in agreement with recent valve‐in‐valve studies, suggests that higher valve placement yields fuller leaflet opening and less resistance to flow through the valve (pressure gradients).…”

Section: Discussionsupporting

confidence: 91%

“…Although THV under‐expansion yields an advantage of reduced thrombosis risk due to less flow stasis, its demerits of increased pressure gradient, and lower EOA may be a cause for concern . This study showed that a 25% underexpanded CoreValve had a 142% higher pressure gradient and 26% lower EOA than a fully expanded one, whereas a 10% underexpanded CoreValve had 36% higher pressure gradient and 10% lower EOA than a fully expanded one.…”

Section: Discussionmentioning

confidence: 68%

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Transcatheter aortic valve deployment influences neo‐sinus thrombosis risk: An in vitro flow study

Madukauwa-David

Sadri

Kamioka

et al. 2019

Cathet Cardio Intervent

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Objectives:We investigated the impact of (transcatheter heart valve) THV expansion at the level of the native annulus and implant depth on valve performance and neo-sinus flow stasis.Background: Flow stasis in the neo-sinus is one of the identified risk factors of THV thrombosis. Methods: A 29 mm CoreValve and 26 mm SAPIEN 3 were deployed under different expansions (CoreValve, SAPIEN 3) and implant depths (CoreValve) within a patientderived aortic root in a pulse duplicator. Fluorescent dye was injected during diastole into the neo-sinus and imaged over 20 cardiac cycles. Washout times were computed as a measure of flow stasis for each deployment.Results: The 10% CoreValve under-expansion improved neo-sinus washout over full expansion by 8% (p < .001), and higher CoreValve implant depth improved neo-sinus washout (p < .001). The 10% SAPIEN 3 under-expansion improved neo-sinus washout by 23% (p < .001). Under-expansion of both valve types caused higher pressure gradients and smaller effective orifice areas than full expansion.Conclusions: Neo-sinus flow stasis is influenced by THV expansion and implant depth (CoreValve). The 10% valve under-deployment (oversizing) may facilitate reduced flow stasis in the neo-sinus with minimal increase in pressure gradients. This strategy may be helpful for patient anatomies, which are in-between transcatheter valve sizes. K E Y W O R D S aortic valve disease, aortic valve disease, percutaneous intervention, transcatheter valve implantation

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 68%

Transcatheter aortic valve deployment influences neo‐sinus thrombosis risk: An in vitro flow study

Madukauwa-David

Sadri

Kamioka

et al. 2019

Cathet Cardio Intervent

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“…Other studies have shown that optimal size and placement of TAVs may exist outside the current guidelines 29, 86, 87 . One possible solution to improve post-procedural gradients and minimize PPM is to implant the TAV in a supra-annular position (Figure 6a), effectively bypassing the geometric constraints imposed by the semi-rigid bioprostheses 86, 116, 158 .…”

Section: Introductionmentioning

confidence: 99%

On the Mechanics of Transcatheter Aortic Valve Replacement

et al. 2016

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Transcatheter aortic valves (TAVs) represent the latest advances in prosthetic heart valve technology. TAVs are truly transformational as they bring the benefit of heart valve replacement to patients that would otherwise not be operated on. Nevertheless, like any new device technology, the high expectations are dampened with growing concerns arising from frequent complications that develop in patients, indicating that the technology is far from being mature. Some of the most common complications that plague current TAV devices include malpositioning, crimp-induced leaflet damage, paravalvular leak, thrombosis, conduction abnormalities and prosthesis-patient mismatch. In this article, we provide an in-depth review of the current state-of-the-art pertaining the mechanics of TAVs while highlighting various studies guiding clinicians, regulatory agencies, and next-generation device designers.

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“…In this study, the larger medium ACn had less leaflet pinwheeling. Pinwheeling is a result of redundant leaflet issue and may have implications for long‐term leaflet function and durability . A high degree of pinwheeling can lead to excessive strain on THV leaflets that may accelerate wear.…”

Section: Discussionmentioning

confidence: 99%

Implications of hydrodynamic testing to guide sizing of self‐expanding transcatheter heart valves for valve‐in‐valve procedures

Sathananthan

Hensey

Fraser

et al. 2019

Cathet Cardio Intervent

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Aims The commonly used valve‐in‐valve (VIV) app recommends sizing based on dimensions of both the transcatheter heart valve (THV) and bioprosthetic surgical valve. The implications of hydrodynamic testing to guide VIV sizing are poorly understood. This bench study assessed the hydrodynamic performance of different sizes of self‐expanding supra‐annular THVs in three different surgical aortic bioprostheses at different implantation depths. Methods A small versus medium ACURATE neo (ACn), and a 26 mm versus 29 mm Evolut R were assessed after VIV implantation in 25 mm Mitroflow, Mosaic, and Magna Ease aortic surgical bioprostheses, at three implantation depths (+2 mm, ‐2 mm, and ‐6 mm). Results The medium‐sized ACn had lower gradients compared to the small ACn when the THV was implanted high (+2 mm, or ‐2 mm). The 29 mm Evolut R had lower gradients compared to a 26 mm Evolut R for all implantation depths, except for a depth of ‐2 mm in the 25 mm Mitroflow. The medium ACn and 29 mm Evolut R had larger effective orifice areas compared to the small ACn and 26 mm Evolut R, respectively. Both Evolut R sizes had acceptable regurgitant fractions (<15%), while both ACn sizes were above the acceptable performance criteria (>15%), at all implantation depths. Conclusions Use of a larger self‐expanding THV was associated with superior hydrodynamic performance if the THV was implanted high. Hydrodynamic testing can provide additional information to the VIV app to help guide VIV sizing.

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Valve Type, Size, and Deployment Location Affect Hemodynamics in an In Vitro Valve-in-Valve Model

Cited by 72 publications

References 25 publications

Transcatheter aortic valve deployment influences neo‐sinus thrombosis risk: An in vitro flow study

Transcatheter aortic valve deployment influences neo‐sinus thrombosis risk: An in vitro flow study

On the Mechanics of Transcatheter Aortic Valve Replacement

Implications of hydrodynamic testing to guide sizing of self‐expanding transcatheter heart valves for valve‐in‐valve procedures

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