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Impact of different aortic valve calcification patterns on the outcome of transcatheter aortic valve implantation: A finite element study
Transcatheter aortic valve implantation (TAVI) can treat symptomatic patients with calcific aortic stenosis. However, the severity and distribution of the calcification of valve leaflets can impair the TAVI efficacy. Here we tackle this issue from a biomechanical standpoint, by finite element simula...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier Science
2016
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5038160/ https://www.ncbi.nlm.nih.gov/pubmed/27059259 http://dx.doi.org/10.1016/j.jbiomech.2016.03.036 |
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author | Sturla, Francesco Ronzoni, Mattia Vitali, Mattia Dimasi, Annalisa Vismara, Riccardo Preston-Maher, Georgia Burriesci, Gaetano Votta, Emiliano Redaelli, Alberto |
author_facet | Sturla, Francesco Ronzoni, Mattia Vitali, Mattia Dimasi, Annalisa Vismara, Riccardo Preston-Maher, Georgia Burriesci, Gaetano Votta, Emiliano Redaelli, Alberto |
author_sort | Sturla, Francesco |
collection | PubMed |
description | Transcatheter aortic valve implantation (TAVI) can treat symptomatic patients with calcific aortic stenosis. However, the severity and distribution of the calcification of valve leaflets can impair the TAVI efficacy. Here we tackle this issue from a biomechanical standpoint, by finite element simulation of a widely adopted balloon-expandable TAVI in three models representing the aortic root with different scenarios of calcific aortic stenosis. We developed a modeling approach realistically accounting for aortic root pressurization and complex anatomy, detailed calcification patterns, and for the actual stent deployment through balloon-expansion. Numerical results highlighted the dependency on the specific calcification pattern of the “dog–boning” of the stent. Also, local stent distortions were associated with leaflet calcifications, and led to localized gaps between the TAVI stent and the aortic tissues, with potential implications in terms of paravalvular leakage. High stresses were found on calcium deposits, which may be a risk factor for stroke; their magnitude and the extent of the affected regions substantially increased for the case of an “arc–shaped” calcification, running from commissure to commissure. Moreover, high stresses due to the interaction between the aortic wall and the leaflet calcifications were computed in the annular region, suggesting an increased risk for annular damage. Our analyses suggest a relation between the alteration of the stresses in the native anatomical components and prosthetic implant with the presence and distribution of relevant calcifications. This alteration is dependent on the patient-specific features of the calcific aortic stenosis and may be a relevant indicator of suboptimal TAVI results. |
format | Online Article Text |
id | pubmed-5038160 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2016 |
publisher | Elsevier Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-50381602016-09-30 Impact of different aortic valve calcification patterns on the outcome of transcatheter aortic valve implantation: A finite element study Sturla, Francesco Ronzoni, Mattia Vitali, Mattia Dimasi, Annalisa Vismara, Riccardo Preston-Maher, Georgia Burriesci, Gaetano Votta, Emiliano Redaelli, Alberto J Biomech Article Transcatheter aortic valve implantation (TAVI) can treat symptomatic patients with calcific aortic stenosis. However, the severity and distribution of the calcification of valve leaflets can impair the TAVI efficacy. Here we tackle this issue from a biomechanical standpoint, by finite element simulation of a widely adopted balloon-expandable TAVI in three models representing the aortic root with different scenarios of calcific aortic stenosis. We developed a modeling approach realistically accounting for aortic root pressurization and complex anatomy, detailed calcification patterns, and for the actual stent deployment through balloon-expansion. Numerical results highlighted the dependency on the specific calcification pattern of the “dog–boning” of the stent. Also, local stent distortions were associated with leaflet calcifications, and led to localized gaps between the TAVI stent and the aortic tissues, with potential implications in terms of paravalvular leakage. High stresses were found on calcium deposits, which may be a risk factor for stroke; their magnitude and the extent of the affected regions substantially increased for the case of an “arc–shaped” calcification, running from commissure to commissure. Moreover, high stresses due to the interaction between the aortic wall and the leaflet calcifications were computed in the annular region, suggesting an increased risk for annular damage. Our analyses suggest a relation between the alteration of the stresses in the native anatomical components and prosthetic implant with the presence and distribution of relevant calcifications. This alteration is dependent on the patient-specific features of the calcific aortic stenosis and may be a relevant indicator of suboptimal TAVI results. Elsevier Science 2016-08-16 /pmc/articles/PMC5038160/ /pubmed/27059259 http://dx.doi.org/10.1016/j.jbiomech.2016.03.036 Text en © 2016 The Authors http://creativecommons.org/licenses/by/4.0/ This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Sturla, Francesco Ronzoni, Mattia Vitali, Mattia Dimasi, Annalisa Vismara, Riccardo Preston-Maher, Georgia Burriesci, Gaetano Votta, Emiliano Redaelli, Alberto Impact of different aortic valve calcification patterns on the outcome of transcatheter aortic valve implantation: A finite element study |
title | Impact of different aortic valve calcification patterns on the outcome of transcatheter aortic valve implantation: A finite element study |
title_full | Impact of different aortic valve calcification patterns on the outcome of transcatheter aortic valve implantation: A finite element study |
title_fullStr | Impact of different aortic valve calcification patterns on the outcome of transcatheter aortic valve implantation: A finite element study |
title_full_unstemmed | Impact of different aortic valve calcification patterns on the outcome of transcatheter aortic valve implantation: A finite element study |
title_short | Impact of different aortic valve calcification patterns on the outcome of transcatheter aortic valve implantation: A finite element study |
title_sort | impact of different aortic valve calcification patterns on the outcome of transcatheter aortic valve implantation: a finite element study |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5038160/ https://www.ncbi.nlm.nih.gov/pubmed/27059259 http://dx.doi.org/10.1016/j.jbiomech.2016.03.036 |
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