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Neo-sinus Flow Stasis Correlates with Thrombus Volume in Patients post-TAVR
Phillip M. Trusty1, Vahid Sadri1, Immanuel David Madukauwa-David1, Emelia Funnell1, Norihiko Kamioka2, Rahul Sharma3, Raj Makkar3, Vasilis Babaliaros2, Ajit P. Yoganathan1.
1Georgia Institute of Technology, Atlanta, GA, USA, 2Emory University School of Medicine, Atlanta, GA, USA, 3Cedars-Sinai Heart Institute, Los Angeles, CA, USA.

OBJECTIVE:
Subclinical leaflet thrombosis is a growing concern in patients post transcatheter aortic valve replacement (TAVR). Thrombus formation in the neo-sinus is of particular interest due to concerns of reduced leaflet motion, THV durability and increased risk of stroke. While flow stasis is thought to play a role in this context, a direct connection between neo-sinus flow stasis and thrombus volume is yet to be established. The objective of this study was to investigate the relationship between thrombus volume and neo-sinus flow stasis using patient-specific modeling.
METHODS:
Patients (n=7) were selected to minimize potential confounding factors related to thrombus formation. Thrombus volume was segmented for each individual neo-sinus. Patient-specific models were created to replicate aortic root and coronary artery anatomy and valve deployment. In vitro experiments were run using the patient-specific cardiac output and idealized left and right coronary flows. Dye was injected into each neo-sinus to quantify washout time as a measure of flow stasis.
RESULTS:
Flow stasis (measured by washout time) showed a strong, positive correlation (r=0.751, p<1e-3) with thrombus volume in the neo-sinus (Figure 1a). Thrombus volume and washout time were highly varied in both inter-patient and intra-patient comparisons. No significant differences were observed in washout time (p=0.36) or thrombus volume (p=0.30) between the left, right and non-coronary neo-sinus (Figure 1b-c). THV cusp angle was significantly correlated with thrombus volume (r=-0.56, p=0.020) and washout time (r=-0.68, p=0.001). Stent height was positively correlated with thrombus volume (r=0.57, p=0.014).
CONCLUSIONS:
This is the first study correlating flow stasis with thrombus volume in the neo-sinus post TAVR. Measurement of neo-sinus flow stasis may guide strategies to improve outcomes in TAVR.


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