Impact of patient-specific morphologies on sinus flow stasis in transcatheter aortic valve replacement: An in?vitro study

摘要

ObjectiveThe goal of this study is to evaluate how sinus flow patterns after transcatheter aortic valve replacement in realistic representative patient roots vary. Sinus flow can affect transcatheter aortic valve operation and likely leaflet thrombosis occurrence due to stasis and poor washout. How the interaction between transcatheter aortic valve and representative patient aortic roots affects sinus hemodynamics is important to establish for future individualization of transcatheter aortic valve replacement therapy.MethodsTwo representative patient aortic roots were selected, segmented and 3-dimensional printed followed by deployment of Medtronic CoreValve (Medtronic Inc, Irvine, Calif) and Edwards SAPIEN (Edwards Lifesciences, Irvine Calif) transcatheter aortic valves. Sinus hemodynamics were assessed in?vitro using high spatio-temporal resolution particle-image-velocimetry. Detailed sinus vortex tracking, shear stress probability density functions, and sinus washout were evaluated and assessed as a function of valve type and representative patient morphology as independent case studies.ResultsPeak velocity in the sinus with SAPIEN valve was approximately 3?times?higher than with CoreValve for both models (0.30?±?0.02?m/s and 0.34?±?0.041?m/s vs 0.13?±?0.01?m/s and 0.10?±?0.02?m/s) (P??1, 77?±?3.2?s?1, 109?±?2.3?s?1, and 250?±?4.1?s?1)?(P?ConclusionsSinus flow dynamics are highly sensitive to aortic root characteristics and transcatheter aortic valve aortic root interaction. Differences in sinus-flow washout and stasis regions between representative patient models may be reflected in different risks of leaflet thrombosis or valve degeneration.