Subclinical Leaflet Thrombosis Following Transcatheter Valve-in-valve Procedures: A Comparative Simulation Study Of Sapien 3 And Corevalve
Dong Qiu, Ali Azadani.
University of Denver, Denver, CO, USA.
OBJECTIVE: Transcatheter aortic valve-in-valve (ViV) implantation is a promising therapy for patients with failed surgical or transcatheter bioprosthetic valves. Recently concerns have been raised about reduced leaflet motion and subclinical leaflet thrombosis following the ViV procedures. This study aimed to estimate the risk of leaflet thrombosis in two separate ViV configurations: (i) ViV with Edwards SAPIEN 3 valve implanted in an intra-annular position, and (ii) ViV with Medtronic CoreValve device implanted in a supra-annular position.
METHODS: A fluid-solid interaction modeling approach was used to quantify blood stasis on the leaflet of a 26-mm Edwards SAPIEN 3 and a 26-mm Medtronic CoreValve implanted in a 25-mm Carpentier-Edwards PERIMOUNT Magna Ease (Figure 1). The three-dimensional flow fields obtained from computational modeling were validated against experimental data obtained in a pulse duplicator system using particle image velocimetry measurements.
RESULTS: The simulation results showed a maximum jet velocity of 2.3 and 2.2 m/s with the CoreValve and SAPIEN 3 devices, respectively. A good agreement was also observed between the simulation results and the experimental data (Figure 1). The simulation results showed a significantly more prolonged blood stasis on the leaflets of the SAPIEN 3 compared to the CoreValve. The contours of blood residence time on the aortic side of the leaflets showed that the regions of high blood stasis were nearly four times larger in the SAPIEN 3 ViV model than the CoreValve ViV model.
CONCLUSIONS: The study suggests that the use of supra-annular transcatheter aortic valves in the ViV procedures has the potential to reduce blood stasis on the leaflets. As a result, the ViV configuration can reduce the likelihood of leaflet thrombosis following transcatheter aortic ViV procedures.
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