Effect of percutaneous aortic valve position on stress map in ascending aorta: A fluid-structure interaction analysis.
Ivan IbanezBruno Alvares de Azevedo GomesAngela Ourivio NieckelePublished in: Artificial organs (2021)
Transcatheter aortic valve implantation (TAVI) is an increasingly widespread procedure. Although this intervention is indicated for high and low surgical risk patients, some issues still remain, such as prosthesis positioning optimization in the aortic annulus. Coaxial positioning of the percutaneous prosthesis influences directly on the aortic wall stress map. The determination of the mechanical stress that acts on the vascular endothelium resulting from blood flow can be considered an important task, since TAVI positioning can lead to unfavorable hemodynamic patterns, resulting in changes in parietal stress, such as those found in post-stenotic dilatation region. This research aims to investigate the influence of the prosthetic valve inclination angle in the mechanical stresses acting in the ascending aortic wall. Aortic compliance and blood flow during cardiac cycle were numerically obtained using fluid structure interaction. The aortic model was developed through segmentation of a computed tomography image of a specific patient submitted to TAVI. When compared to standard position (coaxiality match between the prosthesis and the aortic annulus), the inclination of 4° directed to the left main coronary artery decreased the aortic wall area with high values of wall shear stress and pressure. Coaxial positioning optimization of percutaneous aortic prosthesis may decrease the high mechanical stress area. These changes may be important to reduce the aortic remodeling process, vascular calcification or even the prosthesis half-life. Computational fluid dynamics makes room for personalized medicine, with manufactured prosthesis tailored to each patient.
Keyphrases
- aortic valve
- transcatheter aortic valve implantation
- transcatheter aortic valve replacement
- aortic valve replacement
- aortic stenosis
- blood flow
- coronary artery
- computed tomography
- pulmonary artery
- randomized controlled trial
- deep learning
- end stage renal disease
- ultrasound guided
- left ventricular
- nitric oxide
- case report
- newly diagnosed
- stress induced
- mitral valve
- prognostic factors
- radiofrequency ablation
- mass spectrometry
- pulmonary hypertension
- machine learning
- heat stress
- magnetic resonance
- peritoneal dialysis
- pulmonary arterial hypertension
- patient reported outcomes
- working memory
- solid phase extraction