Cargando…
Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study
The bicuspid aortic valve (BAV) is a common and heterogeneous congenital heart abnormality that is often complicated by aortic stenosis. Although initially developed for tricuspid aortic valves (TAV), transcatheter aortic valve replacement (TAVR) devices are increasingly applied to the treatment of...
Autores principales: | , , , , , , |
---|---|
Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Public Library of Science
2021
|
Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128244/ https://www.ncbi.nlm.nih.gov/pubmed/33999969 http://dx.doi.org/10.1371/journal.pone.0251579 |
_version_ | 1783694082549219328 |
---|---|
author | Kusner, Jonathan Luraghi, Giulia Khodaee, Farhan Rodriguez Matas, José Félix Migliavacca, Francesco Edelman, Elazer R. Nezami, Farhad R. |
author_facet | Kusner, Jonathan Luraghi, Giulia Khodaee, Farhan Rodriguez Matas, José Félix Migliavacca, Francesco Edelman, Elazer R. Nezami, Farhad R. |
author_sort | Kusner, Jonathan |
collection | PubMed |
description | The bicuspid aortic valve (BAV) is a common and heterogeneous congenital heart abnormality that is often complicated by aortic stenosis. Although initially developed for tricuspid aortic valves (TAV), transcatheter aortic valve replacement (TAVR) devices are increasingly applied to the treatment of BAV stenosis. It is known that patient-device relationship between TAVR and BAV are not equivalent to those observed in TAV but the nature of these differences are not well understood. We sought to better understand the patient-device relationships between TAVR devices and the two most common morphologies of BAV. We performed finite element simulation of TAVR deployment into three cases of idealized aortic anatomies (TAV, Sievers 0 BAV, Sievers 1 BAV), derived from patient-specific measurements. Valve leaflet von Mises stress at the aortic commissures differed by valve configuration over a ten-fold range (TAV: 0.55 MPa, Sievers 0: 6.64 MPa, and Sievers 1: 4.19 MPa). First principle stress on the aortic wall was greater in Sievers 1 (0.316 MPa) and Sievers 0 BAV (0.137 MPa) compared to TAV (0.056 MPa). TAVR placement in Sievers 1 BAV demonstrated significant device asymmetric alignment, with 1.09 mm of displacement between the center of the device measured at the annulus and at the leaflet free edge. This orifice displacement was marginal in TAV (0.33 mm) and even lower in Sievers 0 BAV (0.23 mm). BAV TAVR, depending on the subtype involved, may encounter disparate combinations of device under expansion and asymmetry compared to TAV deployment. Understanding the impacts of BAV morphology on patient-device relationships can help improve device selection, patient eligibility, and the overall safety of TAVR in BAV. |
format | Online Article Text |
id | pubmed-8128244 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | Public Library of Science |
record_format | MEDLINE/PubMed |
spelling | pubmed-81282442021-05-27 Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study Kusner, Jonathan Luraghi, Giulia Khodaee, Farhan Rodriguez Matas, José Félix Migliavacca, Francesco Edelman, Elazer R. Nezami, Farhad R. PLoS One Research Article The bicuspid aortic valve (BAV) is a common and heterogeneous congenital heart abnormality that is often complicated by aortic stenosis. Although initially developed for tricuspid aortic valves (TAV), transcatheter aortic valve replacement (TAVR) devices are increasingly applied to the treatment of BAV stenosis. It is known that patient-device relationship between TAVR and BAV are not equivalent to those observed in TAV but the nature of these differences are not well understood. We sought to better understand the patient-device relationships between TAVR devices and the two most common morphologies of BAV. We performed finite element simulation of TAVR deployment into three cases of idealized aortic anatomies (TAV, Sievers 0 BAV, Sievers 1 BAV), derived from patient-specific measurements. Valve leaflet von Mises stress at the aortic commissures differed by valve configuration over a ten-fold range (TAV: 0.55 MPa, Sievers 0: 6.64 MPa, and Sievers 1: 4.19 MPa). First principle stress on the aortic wall was greater in Sievers 1 (0.316 MPa) and Sievers 0 BAV (0.137 MPa) compared to TAV (0.056 MPa). TAVR placement in Sievers 1 BAV demonstrated significant device asymmetric alignment, with 1.09 mm of displacement between the center of the device measured at the annulus and at the leaflet free edge. This orifice displacement was marginal in TAV (0.33 mm) and even lower in Sievers 0 BAV (0.23 mm). BAV TAVR, depending on the subtype involved, may encounter disparate combinations of device under expansion and asymmetry compared to TAV deployment. Understanding the impacts of BAV morphology on patient-device relationships can help improve device selection, patient eligibility, and the overall safety of TAVR in BAV. Public Library of Science 2021-05-17 /pmc/articles/PMC8128244/ /pubmed/33999969 http://dx.doi.org/10.1371/journal.pone.0251579 Text en © 2021 Kusner et al https://creativecommons.org/licenses/by/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. |
spellingShingle | Research Article Kusner, Jonathan Luraghi, Giulia Khodaee, Farhan Rodriguez Matas, José Félix Migliavacca, Francesco Edelman, Elazer R. Nezami, Farhad R. Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study |
title | Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study |
title_full | Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study |
title_fullStr | Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study |
title_full_unstemmed | Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study |
title_short | Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study |
title_sort | understanding tavr device expansion as it relates to morphology of the bicuspid aortic valve: a simulation study |
topic | Research Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8128244/ https://www.ncbi.nlm.nih.gov/pubmed/33999969 http://dx.doi.org/10.1371/journal.pone.0251579 |
work_keys_str_mv | AT kusnerjonathan understandingtavrdeviceexpansionasitrelatestomorphologyofthebicuspidaorticvalveasimulationstudy AT luraghigiulia understandingtavrdeviceexpansionasitrelatestomorphologyofthebicuspidaorticvalveasimulationstudy AT khodaeefarhan understandingtavrdeviceexpansionasitrelatestomorphologyofthebicuspidaorticvalveasimulationstudy AT rodriguezmatasjosefelix understandingtavrdeviceexpansionasitrelatestomorphologyofthebicuspidaorticvalveasimulationstudy AT migliavaccafrancesco understandingtavrdeviceexpansionasitrelatestomorphologyofthebicuspidaorticvalveasimulationstudy AT edelmanelazerr understandingtavrdeviceexpansionasitrelatestomorphologyofthebicuspidaorticvalveasimulationstudy AT nezamifarhadr understandingtavrdeviceexpansionasitrelatestomorphologyofthebicuspidaorticvalveasimulationstudy |