The hemodynamics of transcatheter aortic valves in transcatheter aortic valves.
TAV-in-TAV
TAVR
hemolysis
leaflet thrombosis
turbulence
Journal
The Journal of thoracic and cardiovascular surgery
ISSN: 1097-685X
Titre abrégé: J Thorac Cardiovasc Surg
Pays: United States
ID NLM: 0376343
Informations de publication
Date de publication:
02 2021
02 2021
Historique:
received:
23
05
2019
revised:
22
08
2019
accepted:
06
09
2019
pubmed:
27
11
2019
medline:
18
2
2021
entrez:
27
11
2019
Statut:
ppublish
Résumé
The durability of transcatheter aortic valves (TAVs) remains their greatest disadvantage, given that fixed tissue leaflets are not immune to structural degeneration from calcification and thrombosis. Therefore, a second intervention is necessary, especially given that TAV in low-risk patients has shown noninferior outcomes compared with surgery. This study aimed to assess the hemodynamic and turbulent properties of the flow downstream with different TAV-in-TAV configurations, to offer basic hemodynamic guidance for future interventions when currently implanted valves structurally degrade. Six TAV-in-TAV configurations were chosen: 23 mm Evolut-in-26 mm Evolut, 23 mm Evolut-in-23 mm SAPIEN 3, 26 mm Evolut-in-26 mm Evolut, 26 mm Evolut-in-23 mm SAPIEN 3, 23 mm SAPIEN3-in-26 mm Evolut, and 23 mm SAPIEN3-in-23 mm SAPIEN 3. Their hemodynamic performance was assessed in a pulse duplicator for 100 cycles. High-speed imaging and particle image velocimetry were performed to assess turbulence. Effective orifice area (EOA), pinwheeling index (PI), and Reynolds shear stress (RSS) were evaluated. The largest mean EOA was obtained with 23 mm SAPIEN-in-26 mm Evolut (2.07 ± 0.06 cm This study shows that best hemodynamic parameters are TAV-specific (implanted and to be implanted). In addition, it shows that RSS levels, which are indicative of turbulence levels and associated with blood damage, are 2- to 3-fold higher after TAV-in-TAV.
Sections du résumé
BACKGROUND
The durability of transcatheter aortic valves (TAVs) remains their greatest disadvantage, given that fixed tissue leaflets are not immune to structural degeneration from calcification and thrombosis. Therefore, a second intervention is necessary, especially given that TAV in low-risk patients has shown noninferior outcomes compared with surgery. This study aimed to assess the hemodynamic and turbulent properties of the flow downstream with different TAV-in-TAV configurations, to offer basic hemodynamic guidance for future interventions when currently implanted valves structurally degrade.
METHODS
Six TAV-in-TAV configurations were chosen: 23 mm Evolut-in-26 mm Evolut, 23 mm Evolut-in-23 mm SAPIEN 3, 26 mm Evolut-in-26 mm Evolut, 26 mm Evolut-in-23 mm SAPIEN 3, 23 mm SAPIEN3-in-26 mm Evolut, and 23 mm SAPIEN3-in-23 mm SAPIEN 3. Their hemodynamic performance was assessed in a pulse duplicator for 100 cycles. High-speed imaging and particle image velocimetry were performed to assess turbulence. Effective orifice area (EOA), pinwheeling index (PI), and Reynolds shear stress (RSS) were evaluated.
RESULTS
The largest mean EOA was obtained with 23 mm SAPIEN-in-26 mm Evolut (2.07 ± 0.06 cm
CONCLUSIONS
This study shows that best hemodynamic parameters are TAV-specific (implanted and to be implanted). In addition, it shows that RSS levels, which are indicative of turbulence levels and associated with blood damage, are 2- to 3-fold higher after TAV-in-TAV.
Identifiants
pubmed: 31767355
pii: S0022-5223(19)32354-2
doi: 10.1016/j.jtcvs.2019.09.174
pmc: PMC7197105
mid: NIHMS1542370
pii:
doi:
Types de publication
Journal Article
Video-Audio Media
Langues
eng
Sous-ensembles de citation
IM
Pagination
565-576.e2Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL119824
Pays : United States
Organisme : NHLBI NIH HHS
ID : R01 HL135505
Pays : United States
Organisme : NIBIB NIH HHS
ID : R03 EB014255
Pays : United States
Commentaires et corrections
Type : CommentIn
Type : CommentIn
Informations de copyright
Copyright © 2019 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.
Références
Lancet. 2017 Jun 17;389(10087):2383-2392
pubmed: 28330690
J Thorac Cardiovasc Surg. 2014 Aug;148(2):492-9.e1
pubmed: 24263005
JACC Cardiovasc Interv. 2019 May 27;12(10):901-907
pubmed: 30860059
Biomech Model Mechanobiol. 2014 Aug;13(4):759-70
pubmed: 24092257
Int J Artif Organs. 1990 May;13(5):300-6
pubmed: 2365485
Ann Biomed Eng. 2019 Jan;47(1):75-84
pubmed: 30151733
Ann Biomed Eng. 2017 Feb;45(2):310-331
pubmed: 27873034
J Thorac Cardiovasc Surg. 2018 Nov;156(5):1837-1848
pubmed: 29961588
J Artif Organs. 2014 Jun;17(2):178-85
pubmed: 24619800
J Am Coll Cardiol. 2019 Feb 12;73(5):546-553
pubmed: 30732707
J Thorac Cardiovasc Surg. 2019 Feb;157(2):540-549
pubmed: 29980299
JACC Cardiovasc Imaging. 2019 Jan;12(1):135-145
pubmed: 30448122
Ann Biomed Eng. 2018 Dec;46(12):2102-2111
pubmed: 30030772
ASAIO J. 2004 Sep-Oct;50(5):418-23
pubmed: 15497379
Am J Cardiol. 2015 Jun 1;115(11):1574-9
pubmed: 25862156
J Thorac Cardiovasc Surg. 2019 Feb 21;:
pubmed: 30905419
Ann Biomed Eng. 2014 Jun;42(6):1195-206
pubmed: 24719050
Ann Biomed Eng. 2019 Jan;47(1):85-96
pubmed: 30209706
J Am Coll Cardiol. 2019 Feb 12;73(5):537-545
pubmed: 30732706
N Engl J Med. 2019 May 2;380(18):1695-1705
pubmed: 30883058
J Am Coll Cardiol. 2018 Oct 30;72(18):2095-2105
pubmed: 30170075
Annu Rev Biomed Eng. 2004;6:331-62
pubmed: 15255773
J Thorac Cardiovasc Surg. 2017 Jul;154(1):32-43.e1
pubmed: 28433356
JACC Cardiovasc Interv. 2016 Aug 8;9(15):1618-28
pubmed: 27491613
J Thorac Cardiovasc Surg. 2014 Dec;148(6):2877-82.e1
pubmed: 25227698
J R Soc Interface. 2015 Dec 6;12(113):20150737
pubmed: 26674192
J Biomech. 1992 Apr;25(4):429-40
pubmed: 1583021
Eur J Cardiothorac Surg. 2017 Mar 1;51(3):562-570
pubmed: 27773869
J Appl Physiol. 1972 Feb;32(2):261-4
pubmed: 5007881
J Thorac Cardiovasc Surg. 2001 Aug;122(2):287-95
pubmed: 11479501
Circ Cardiovasc Interv. 2019 Feb;12(2):e007349
pubmed: 30732472
Ann Thorac Surg. 2018 Jul;106(1):70-78
pubmed: 29501642
J Am Coll Cardiol. 2014 Jun 10;63(22):e57-185
pubmed: 24603191
Circ Cardiovasc Interv. 2015 Aug;8(8):e001945
pubmed: 26206850
PLoS One. 2014 Aug 29;9(8):e105357
pubmed: 25171175