Abstract
Gated computed tomography (CT) might not adequately predict occurrence of post-implantation transcatheter aortic valve replacement (TAVR) complications in hostile aortic root as it would require a more complex integration of morphological, functional and hemodynamical parameters. We used a computational framework based on finite element analysis (FEA) to simulate patient-specific implantation. Application of biomechanical modelling using FEA to gated-CT was able to demonstrate the relation of the device with voluminous calcification, its consequent misalignment and a significant stent deformation. Use of FEA and other advanced computed predictive modelling techniques as an adjunct to CT scan could improve our understanding of TAVR, potentially predict complications and fate of the devices after implantation and inform patient-specific treatment.
Highlights
The use of transcatheter aortic valve replacement (TAVR) is still hampered by daunting complications mainly related to hostile anatomical characteristics of the aortic root
Biomechanical modelling and finite element analysis (FEA) was performed on pre-procedural computed tomography (CT) scans to simulate implantation and infer potential complications deriving from the patient-specific aortic root anatomy and calcification distribution
CT scan at the moment of readmission showed a marked change in the size of the annulus and in the height of the coronaries relative to annulus (3 mm for the right coronary and 5 mm for the left coronary; change from baseline −7 mm and −6 mm respectively) (Table 1)
Summary
The use of transcatheter aortic valve replacement (TAVR) is still hampered by daunting complications mainly related to hostile anatomical characteristics of the aortic root. The presence of voluminous calcifications can severely impair device deployment leading to paravalvular regurgitation [1,2,3] valvular complications [4] or stress damage to the aorta [5]. The use of finite element analysis (FEA) and other advanced computed predictive modelling techniques [4,5,6,7,8,9,10,11] in combination with CT scan could improve our understanding of TAVR, potentially predict complications and tailor patient-specific implantations
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