Predictive Model for Thrombus Formation After Transcatheter Valve Replacement.
Flow stasis
Leaflet thrombosis
Neosinus
Predictive Model
Transcatheter aortic valve replacement
Journal
Cardiovascular engineering and technology
ISSN: 1869-4098
Titre abrégé: Cardiovasc Eng Technol
Pays: United States
ID NLM: 101531846
Informations de publication
Date de publication:
12 2021
12 2021
Historique:
received:
12
01
2021
accepted:
09
11
2021
pubmed:
4
12
2021
medline:
1
1
2022
entrez:
3
12
2021
Statut:
ppublish
Résumé
Leaflet thrombosis is a significant adverse event after transcatheter aortic valve (TAV) replacement (TAVR). The purpose of our study was to present a semi-empirical, mathematical model that links patient-specific anatomic, valve, and flow parameters to predict likelihood of leaflet thrombosis. The two main energy sources of neo-sinus (NS) washout after TAVR include the jet flow downstream of the TAV and NS geometric change in volume due to the leaflets opening and closing. Both are highly dependent on patient anatomic and hemodynamic factors. As rotation of blood flow is prevalent in both the sinus of Valsalva and then the NS, we adopted the vorticity flux or circulation (Г) as a metric quantifying overall washout. Leaflet thrombus volumes were segmented based on hypo-attenuating leaflet thickening (HALT) in post-TAVR patient's gated computed tomography. Г was assessed using dimensional scaling as well as computational fluid dynamics (CFD) respectively and correlated to the thrombosis volumes using sensitivity and specificity analysis. Г in the NS, that accounted for patient flow and anatomic conditions derived from scaling arguments significantly better predicted the occurrence of leaflet thrombus than CFD derived measures such as stasis volumes or wall shear stress. Given results from the six patient datasets considered herein, a threshold Г value of 28.0 yielded a sensitivity and specificity of 100% where patients with Gamma < 28 developed valve thrombosis. A 10% error in measurements of all variables can bring the sensitivity specificity down to 87%. A predictive model relating likelihood of valve thrombosis using Г in the NS was developed with promising sensitivity and specificity. With further studies and improvements, this predictive technology may lead to alerting physicians on the risk for thrombus formation following TAVR.
Identifiants
pubmed: 34859378
doi: 10.1007/s13239-021-00596-x
pii: 10.1007/s13239-021-00596-x
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
576-588Subventions
Organisme : NHLBI NIH HHS
ID : R01 HL119824
Pays : United States
Organisme : American Heart Association
ID : 19POST34380804
Commentaires et corrections
Type : ErratumIn
Informations de copyright
© 2021. Biomedical Engineering Society.
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