Fluid Study of Transcatheter Aortic Valve Deployment Into Patients With Varying Coronary Ostia Position

Recently, minimally-invasive transcatheter aortic valve (TAV) replacement has emerged as a viable alternative to traditional open-chest heart valve replacement for high risk patients who otherwise have limited or no treatment options. Although significant experience with TAV procedures has been gained, various adverse effects have been observed after device implantation [1, 2]. One adverse event is the impairment of coronary artery flow. Because the TAV stent pushes the native leaflets towards the sinus of Valsalva during TAV deployment, the flow boundaries in the aortic root are consequently altered. A worst case scenario would be the occlusion of the coronary ostia. Reduced flow to the coronary arteries has also been observed for some patients following TAV intervention [3]. With IRB approval, we recently conducted a dimensional analysis of 3D aortic root geometries, reconstructed from 64-slice CT scans of 95 patients [4]. TAV-relevant dimensions were measured. The spatial distribution of the left coronary ostium was quantified (Fig. 1). In this study, we will construct a patient-specific aortic root model with varied coronary ostium locations as shown in Fig. 1, and perform a combined finite element analysis (FEA) and computational fluid dynamics (CFD) simulation to investigate hemodynamic environment changes that occur following TAV intervention.