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The Effect of Valve-in-Valve Implantation Height on Sinus Flow

  • The Pursuit of Engineering the Ideal Heart Valve Replacement or Repair
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Abstract

Valve-in-valve transcatheter aortic valve replacement (VIV-TAVR) has proven to be a successful treatment for high risk patients with failing aortic surgical bioprostheses. However, thrombus formation on the leaflets of the valve has emerged as a major issue in such procedures, posing a risk of restenosis, thromboembolism, and reduced durability. In this work we attempted to understand the effect of deployment position of the transcatheter heart valve (THV) on the spatio-temporal flow field within the sinus in VIV-TAVR. Experiments were performed in an in vitro pulsatile left heart simulator using high-speed Particle Image Velocimetry (PIV) to measure the flow field in the sinus region. The time-resolved velocity data was used to understand the qualitative and quantitative flow patterns. In addition, a particle tracking technique was used to evaluate relative thrombosis risk via sinus washout. The velocity data demonstrate that implantation position directly affects sinus flow patterns, leading to increased flow stagnation with increasing deployment height. The particle tracking simulations showed that implantation position directly affected washout time, with the highest implantation resulting in the least washout. These results clearly demonstrate the flow pattern and flow stagnation in the sinus is sensitive to THV position. It is, therefore, important for the interventional cardiologist and cardiac surgeon to consider how deployment position could impact flow stagnation during VIV-TAVR.

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Abbreviations

VIV:

Valve-in-valve

TAVR:

Transcatheter aortic valve replacement

THV:

Transcatheter heart valve

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Acknowledgments

The authors would like to acknowledge the members of the Cardiovascular Fluid Mechanics Laboratory for their assistance and feedback. The authors are grateful to our collaborators at Emory University Hospital—Drs. Vinod Thourani, Vasilis Babaliaros, Stamatios Lerakis, and Jose Condado for providing the valve models and assistance with placing the work in the context of clinical relevance. The glycerin used in this study was generously provided by Procter & Gamble. This study at the CFM lab at the Georgia Institute of Technology was made possible through discretionary funds available to the Principal Investigator including the Wallace H Coulter Endowed Chair.

Conflicts of Interest

The authors have no conflict of interest to disclose.

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Authors and Affiliations

  1. George W. Woodruff School of Mechanical Engineering, Georgia Institute of Technology, Atlanta, GA, USA

    Prem A. Midha

  2. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology & Emory University, Technology Enterprise Park, Suite 200, 387 Technology Circle, Atlanta, GA, 30313-2412, USA

    Vrishank Raghav & Ajit P. Yoganathan

  3. School of Chemical & Biomolecular Engineering, Georgia Institute of Technology, Atlanta, GA, USA

    Ikechukwu Okafor

Authors
  1. Prem A. Midha
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  2. Vrishank Raghav
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  3. Ikechukwu Okafor
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  4. Ajit P. Yoganathan
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Corresponding author

Correspondence to Ajit P. Yoganathan.

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Associate Editor Lakshmi Prasad Dasi oversaw the review of this article.

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Midha, P.A., Raghav, V., Okafor, I. et al. The Effect of Valve-in-Valve Implantation Height on Sinus Flow. Ann Biomed Eng 45, 405–412 (2017). https://doi.org/10.1007/s10439-016-1642-2

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  • DOI: https://doi.org/10.1007/s10439-016-1642-2

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