Biomechanics of Transcatheter Aortic Valve Replacement Complications and Computational Predictive Modeling

• Type of Material: Article
• Authors: Fateme Esmailie, Emory University School of Medicine; Atefah Razavi, Emory University School of Medicine; Breandan Yeats, Emory University School of Medicine; Sri Krishna Sivakumar, Emory University School of Medicine; Huang Chen, Emory University School of Medicine; Milad Samaee, Emory University School of Medicine; Imran A Shah, Emory University School of Medicine; Alessandro Veneziani, Emory University; Pradeep Yadav, Piedmont Heart Institute; Vinod Thourani, Emory University; Lakshmi Dasi, Emory University
• Language: English
• Date: 2022-06-01
• Publisher: Elsevier Inc.,
• Publication Version: Final Published Version
• Copyright Statement: © 2022 The Authors. Published by Elsevier Inc. on behalf of Cardiovascular Research Foundation.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.shj.2022.100032
• Title of Journal or Parent Work: Structural Heart
• Volume: 6
• Issue: 2
• Start Page: 100032
• End Page: 100032
• Grant/Funding Information: Funding for this paper was provided by the National Heart, Lung, and Blood Institute of the National Institutes of Health under award number 7R01HL135505-04.
• Keywords: Root rupture; Patient prosthesis mismatch; Coronary obstruction; Permanent pacemaker implantation; Computational predictive models; Leaflet thrombosis
• Research Categories: Engineering, Biomedical

Abstract

Transcatheter aortic valve replacement (TAVR) is a rapidly growing field enabling replacement of diseased aortic valves without the need for open heart surgery. However, due to the nature of the procedure and nonremoval of the diseased tissue, there are rates of complications ranging from tissue rupture and coronary obstruction to paravalvular leak, valve thrombosis, and permanent pacemaker implantation. In recent years, computational modeling has shown a great deal of promise in its capabilities to understand the biomechanical implications of TAVR as well as help preoperatively predict risks inherent to device–patient-specific anatomy biomechanical interaction. This includes intricate replication of stent and leaflet designs and tested and validated simulated deployments with structural and fluid mechanical simulations. This review outlines current biomechanical understanding of device-related complications from TAVR and related predictive strategies using computational modeling. An outlook on future modeling strategies highlighting reduced order modeling which could significantly reduce the high time and cost that are required for computational prediction of TAVR outcomes is presented in this review paper. A summary of current commercial/in-development software is presented in the final section.