Quantitative assessment of paravalvular leakage after transcatheter aortic valve replacement using a patient-specific pulsatile flow model

Yutaka Tanaka, Shigeru Saito, Saeko Sasuga, Azuma Takahashi, Yusuke Aoyama, Kazuto Obama, Mitsuo Umezu, Kiyotaka Iwasaki

    Research output: Contribution to journalArticle

    5 Citations (Scopus)

    Abstract

    Background: Quantitative assessment of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR) remains challenging. We developed patient-specific anatomical models with pulsatile flow circuit and investigated factors associated with AR after TAVR. Methods: Based on pre-procedural computed tomography (CT) data of the six patients who underwent transfemoral TAVR using a 23-mm SAPIEN XT, anatomically and mechanically equivalent aortic valve models were developed. Forward flow and heart rate of each patient in two days after TAVR were duplicated under mean aortic pressure of 80 mm Hg. Paravalvular leakage (PVL) volume in basal and additional conditions was measured for each model using an electromagnetic flow sensor. Incompletely apposed tract between the transcatheter and aortic valves was examined using a micro-CT. Results: PVL volume in each patient-specific model was consistent with each patient's PVL grade, and was affected by hemodynamic conditions. PVL and total regurgitation volume increased with the mean aortic pressure, whereas closing volume did not change. In contrast, closing volume increased proportionately with heart rate, but PVL did not change. The minimal cross-sectional gap had a positive correlation with the PVL volumes (r = 0.89, P = 0.02). The gap areas typically occurred in the vicinity of the bulky calcified nodules under the native commissure. Conclusions: PVL volume, which could be affected by hemodynamic conditions, was significantly associated with the minimal cross-sectional gap area between the aortic annulus and the stent frame. These data may improve our understanding of the mechanism of the occurrence of post-TAVR PVL.

    Original languageEnglish
    Pages (from-to)313-320
    Number of pages8
    JournalInternational Journal of Cardiology
    Volume258
    DOIs
    Publication statusPublished - 2018 May 1

    Fingerprint

    Pulsatile Flow
    Closing Volume
    Aortic Valve Insufficiency
    Aortic Valve
    Arterial Pressure
    Heart Rate
    Hemodynamics
    Tomography
    Anatomic Models
    Electromagnetic Phenomena
    Stents
    Transcatheter Aortic Valve Replacement

    Keywords

    • Functional modeling
    • Paravalvular leakage
    • Transcatheter aortic valve replacement

    ASJC Scopus subject areas

    • Cardiology and Cardiovascular Medicine

    Cite this

    Quantitative assessment of paravalvular leakage after transcatheter aortic valve replacement using a patient-specific pulsatile flow model. / Tanaka, Yutaka; Saito, Shigeru; Sasuga, Saeko; Takahashi, Azuma; Aoyama, Yusuke; Obama, Kazuto; Umezu, Mitsuo; Iwasaki, Kiyotaka.

    In: International Journal of Cardiology, Vol. 258, 01.05.2018, p. 313-320.

    Research output: Contribution to journalArticle

    Tanaka, Yutaka ; Saito, Shigeru ; Sasuga, Saeko ; Takahashi, Azuma ; Aoyama, Yusuke ; Obama, Kazuto ; Umezu, Mitsuo ; Iwasaki, Kiyotaka. / Quantitative assessment of paravalvular leakage after transcatheter aortic valve replacement using a patient-specific pulsatile flow model. In: International Journal of Cardiology. 2018 ; Vol. 258. pp. 313-320.
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    AU - Tanaka, Yutaka

    AU - Saito, Shigeru

    AU - Sasuga, Saeko

    AU - Takahashi, Azuma

    AU - Aoyama, Yusuke

    AU - Obama, Kazuto

    AU - Umezu, Mitsuo

    AU - Iwasaki, Kiyotaka

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    AB - Background: Quantitative assessment of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR) remains challenging. We developed patient-specific anatomical models with pulsatile flow circuit and investigated factors associated with AR after TAVR. Methods: Based on pre-procedural computed tomography (CT) data of the six patients who underwent transfemoral TAVR using a 23-mm SAPIEN XT, anatomically and mechanically equivalent aortic valve models were developed. Forward flow and heart rate of each patient in two days after TAVR were duplicated under mean aortic pressure of 80 mm Hg. Paravalvular leakage (PVL) volume in basal and additional conditions was measured for each model using an electromagnetic flow sensor. Incompletely apposed tract between the transcatheter and aortic valves was examined using a micro-CT. Results: PVL volume in each patient-specific model was consistent with each patient's PVL grade, and was affected by hemodynamic conditions. PVL and total regurgitation volume increased with the mean aortic pressure, whereas closing volume did not change. In contrast, closing volume increased proportionately with heart rate, but PVL did not change. The minimal cross-sectional gap had a positive correlation with the PVL volumes (r = 0.89, P = 0.02). The gap areas typically occurred in the vicinity of the bulky calcified nodules under the native commissure. Conclusions: PVL volume, which could be affected by hemodynamic conditions, was significantly associated with the minimal cross-sectional gap area between the aortic annulus and the stent frame. These data may improve our understanding of the mechanism of the occurrence of post-TAVR PVL.

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