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Effect of Sinotubular Junction Size on TAVR Leaflet Thrombosis: A Fluid–Structure Interaction Analysis.
- Source :
- Annals of Biomedical Engineering; Mar2024, Vol. 52 Issue 3, p719-733, 15p
- Publication Year :
- 2024
-
Abstract
- TAVR has emerged as a standard approach for treating severe aortic stenosis patients. However, it is associated with several clinical complications, including subclinical leaflet thrombosis characterized by Hypoattenuated Leaflet Thickening (HALT). A rigorous analysis of TAVR device thrombogenicity considering anatomical variations is essential for estimating this risk. Clinicians use the Sinotubular Junction (STJ) diameter for TAVR sizing, but there is a paucity of research on its influence on TAVR devices thrombogenicity. A Medtronic Evolut® TAVR device was deployed in three patient models with varying STJ diameters (26, 30, and 34 mm) to evaluate its impact on post-deployment hemodynamics and thrombogenicity, employing a novel computational framework combining prosthesis deployment and fluid-structure interaction analysis. The 30 mm STJ patient case exhibited the best hemodynamic performance: 5.94 mmHg mean transvalvular pressure gradient (TPG), 2.64 cm<superscript>2</superscript> mean geometric orifice area (GOA), and the lowest mean residence time (T<subscript>R</subscript>)—indicating a reduced thrombogenic risk; 26 mm STJ exhibited a 10 % reduction in GOA and a 35% increase in mean TPG compared to the 30 mm STJ; 34 mm STJ depicted hemodynamics comparable to the 30 mm STJ, but with a 6% increase in T<subscript>R</subscript> and elevated platelet stress accumulation. A smaller STJ size impairs adequate expansion of the TAVR stent, which may lead to suboptimal hemodynamic performance. Conversely, a larger STJ size marginally enhances the hemodynamic performance but increases the risk of TAVR leaflet thrombosis. Such analysis can aid pre-procedural planning and minimize the risk of TAVR leaflet thrombosis. [ABSTRACT FROM AUTHOR]
Details
- Language :
- English
- ISSN :
- 00906964
- Volume :
- 52
- Issue :
- 3
- Database :
- Complementary Index
- Journal :
- Annals of Biomedical Engineering
- Publication Type :
- Academic Journal
- Accession number :
- 175359227
- Full Text :
- https://doi.org/10.1007/s10439-023-03419-3