Paravalvular leak (PVL) is a relatively frequent complication after transcatheter aortic valve replacement (TAVR) with increased mortality. Currently, there is no effective method to pre-operatively predict and prevent PVL. In this study, we developed a computational model to predict the severity of PVL after TAVR. Nonlinear finite element (FE) method was used to simulate a self-expandable CoreValve deployment into a patient-specific aortic root, specified with human material properties of aortic tissues. Subsequently, computational fluid dynamics (CFD) simulations were performed using the post-TAVR geometries from the FE simulation, and a parametric investigation of the impact of the transcatheter aortic valve (TAV) skirt shape, TAV orientation, and deployment height on PVL was conducted. The predicted PVL was in good agreement with the echocardiography data. Due to the scallop shape of CoreValve skirt, the difference of PVL due to TAV orientation can be as large as 40%. Although the stent thickness is small compared to the aortic annulus size, we found that inappropriate modeling of it can lead to an underestimation of PVL up to 10 ml/beat. Moreover, the deployment height could significantly alter the extent and the distribution of regurgitant jets, which results in a change of leaking volume up to 70%. Further investigation in a large cohort of patients is warranted to verify the accuracy of our model. This study demonstrated that a rigorously developed patient-specific computational model can provide useful insights into underlying mechanisms causing PVL and potentially assist in pre-operative planning for TAVR to minimize PVL.
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October 2018
Research-Article
Numerical Parametric Study of Paravalvular Leak Following a Transcatheter Aortic Valve Deployment Into a Patient-Specific Aortic Root
Wenbin Mao,
Wenbin Mao
Tissue Mechanics Laboratory,
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology
and Emory University,
Atlanta, GA 30313-2412
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology
and Emory University,
Atlanta, GA 30313-2412
Search for other works by this author on:
Qian Wang,
Qian Wang
Tissue Mechanics Laboratory,
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology
and Emory University,
Atlanta, GA 30313-2412
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology
and Emory University,
Atlanta, GA 30313-2412
Search for other works by this author on:
Susheel Kodali,
Susheel Kodali
Division of Cardiology,
Columbia University Medical Center,
New York 10032
Columbia University Medical Center,
New York 10032
Search for other works by this author on:
Wei Sun
Wei Sun
Tissue Mechanics Laboratory,
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology
and Emory University,
206 Technology Enterprise Park,
Georgia Institute of Technology,
387 Technology Circle,
Atlanta, GA 30313-2412
e-mail: wei.sun@bme.gatech.edu
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology
and Emory University,
206 Technology Enterprise Park,
Georgia Institute of Technology,
387 Technology Circle,
Atlanta, GA 30313-2412
e-mail: wei.sun@bme.gatech.edu
Search for other works by this author on:
Wenbin Mao
Tissue Mechanics Laboratory,
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology
and Emory University,
Atlanta, GA 30313-2412
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology
and Emory University,
Atlanta, GA 30313-2412
Qian Wang
Tissue Mechanics Laboratory,
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology
and Emory University,
Atlanta, GA 30313-2412
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology
and Emory University,
Atlanta, GA 30313-2412
Susheel Kodali
Division of Cardiology,
Columbia University Medical Center,
New York 10032
Columbia University Medical Center,
New York 10032
Wei Sun
Tissue Mechanics Laboratory,
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology
and Emory University,
206 Technology Enterprise Park,
Georgia Institute of Technology,
387 Technology Circle,
Atlanta, GA 30313-2412
e-mail: wei.sun@bme.gatech.edu
The Wallace H. Coulter Department
of Biomedical Engineering,
Georgia Institute of Technology
and Emory University,
206 Technology Enterprise Park,
Georgia Institute of Technology,
387 Technology Circle,
Atlanta, GA 30313-2412
e-mail: wei.sun@bme.gatech.edu
1Corresponding author.
Manuscript received November 20, 2017; final manuscript received May 28, 2018; published online June 21, 2018. Assoc. Editor: Alison Marsden.
J Biomech Eng. Oct 2018, 140(10): 101007 (11 pages)
Published Online: June 21, 2018
Article history
Received:
November 20, 2017
Revised:
May 28, 2018
Citation
Mao, W., Wang, Q., Kodali, S., and Sun, W. (June 21, 2018). "Numerical Parametric Study of Paravalvular Leak Following a Transcatheter Aortic Valve Deployment Into a Patient-Specific Aortic Root." ASME. J Biomech Eng. October 2018; 140(10): 101007. https://doi.org/10.1115/1.4040457
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