Abstract
Background: Transcatheter aortic valve replacement has proved its safety and effectiveness in intermediate- to high-risk and inoperable patients with severe aortic stenosis. However, despite current guideline recommendations, the use of transcatheter aortic valve replacement (TAVR) to treat severe aortic valve stenosis caused by degenerative leaflet thickening and calcification has not been widely adopted in low-risk patients. This reluctance among both cardiac surgeons and cardiologists could be due to concerns regarding clinical and subclinical valve thrombosis. Stent performance alongside increased aortic root and leaflet stresses in surgical bioprostheses has been correlated with complications such as thrombosis, migration and structural valve degeneration. Materials and Methods: Self-expandable catheter-based aortic valve replacement (Medtronic, Minneapolis, MN, USA), which was received by patients who developed transcatheter heart valve thrombosis, was investigated using high-resolution biomodelling from computed tomography scanning. Calcific blocks were extracted from a 250 CT multi-slice image for precise three-dimensional geometry image reconstruction of the root and leaflets. Results: Distortion of the stent was observed with incomplete cranial and caudal expansion of the device. The incomplete deployment of the stent was evident in the presence of uncrushed refractory bulky calcifications. This resulted in incomplete alignment of the device within the aortic root and potential dislodgment. Conclusion: A Finite Element Analysis (FEA) investigation can anticipate the presence of calcified refractory blocks, the deformation of the prosthetic stent and the development of paravalvular orifice, and it may prevent subclinical and clinical TAVR thrombosis. Here we clearly demonstrate that using exact geometry from high-resolution CT scans in association with FEA allows detection of persistent bulky calcifications that may contribute to thrombus formation after TAVR procedure.
Highlights
Transcatheter aortic valve replacement (TAVR) is a common cardiac operation performed worldwide
Thrombotic formation was detected at transthoracic echocardiography (TTE) and subsequent transoesophageal echocardiography (TEE)
Just a few years ago, the heart surgery community experienced a reversal of the trend of standard operation for aortic valve replacement, and there was a drastic reduction in the number of mechanical prostheses implanted compared to stented xenografts [22,23] because thrombosis in surgical bioprosthesis occurs more rarely (1%–2% of recipients) [24], which is significantly less compared to the modern-day transcatheter aortic valve replacement (TAVR) [17,23]
Summary
Transcatheter aortic valve replacement (TAVR) is a common cardiac operation performed worldwide. Despite current guideline recommendations, the use of transcatheter aortic valve replacement (TAVR) to treat severe aortic valve stenosis caused by degenerative leaflet thickening and calcification has not been widely adopted in low-risk patients. This reluctance among both cardiac surgeons and cardiologists could be due to concerns regarding clinical and subclinical valve thrombosis. The incomplete deployment of the stent was evident in the presence of uncrushed refractory bulky calcifications This resulted in incomplete alignment of the device within the aortic root and potential dislodgment.
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