The Impact of Self-Expandable Transcatheter Aortic Valve Replacement on Concomitant Functional Mitral Regurgitation: A Comprehensive Engineering Analysis. Issue 3 (3rd May 2020)

• Record Type: Journal Article
• Authors: Caballero, Andrés; Mao, Wenbin; McKay, Raymond; Sun, Wei
• Is Part Of: Structural heart. Volume 4:Issue 3(2020)
• Page Start: 179
• Page End: 191
• Publication Date: 2020-05-03
• Subjects: Aortic-mitral coupling -- mitral regurgitation -- transcatheter aortic valve replacement -- bicuspid aortic valve -- fluid-structure interaction -- echocardiography -- hemodynamics; Heart -- Diseases -- Periodicals; Congenital heart disease -- Periodicals; Cardiovascular system -- Diseases -- Periodicals; Cardiovascular Diseases; Cardiovascular system -- Diseases; Congenital heart disease; Heart -- Diseases; Periodicals; 616.12
• DOI: 10.1080/24748706.2020.1740365
• Languages: English
• ISSNs: 2474-8706

Abstract

ABSTRACT: Background: : Mitral regurgitation (MR) is present in a large proportion of patients who undergo transcatheter aortic valve replacement (TAVR). However, existing clinical data on the impact of TAVR on early post-procedural MR severity are contradictory. Using a comprehensive computational engineering methodology, this study aimed to quantitatively evaluate the structural and hemodynamic impact of TAVR on aortic-mitral continuity and MR severity in a rigorously developed and validated patient-specific left heart (LH) computer model with aortic stenosis and concomitant functional MR. Methods: : TAVR procedure was virtually simulated using a self-expandable valve (SEV) at three implantation heights. Pre- and post-TAVR LH dynamics as well as intra-operative biomechanics were analyzed. Results: : No significant differences in early MR improvement (<10%) were noted at the three implantation depths when compared to the pre-TAVR state. The high deployment model resulted in the highest stress in the native aortic leaflets, lowest stent-tissue contact force, highest aortic-mitral angle, and highest MR reduction for this patient case. When comparing SEV vs. balloon-expandable valve (BEV) performance at an optimal implantation height, the SEV gave a higher regurgitant volume than the pre-TAVR model (40.49 vs 37.59 ml), while the BEV model gave the lowest regurgitant volume (33.84 vs 37.59 ml). Conclusions: : Contact force, aortic-mitral angle, and valve annuli compression were identified as possible mechanistic parameters that may suggest avenues for acute MR improvement. Albeit a single patient parametric study, it is our hope that such detailed engineering analysis could shed some light into the underlying biomechanical mechanisms of TAVR impact on MR.