Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study.

The bicuspid aortic valve (BAV) is a common and heterogeneous congenital heart abnormality that is often complicated by aortic stenosis. Although initially developed for tricuspid aortic valves (TAV), transcatheter aortic valve replacement (TAVR) devices are increasingly applied to the treatment of...

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Autores principales:	Jonathan Kusner, Giulia Luraghi, Farhan Khodaee, José Félix Rodriguez Matas, Francesco Migliavacca, Elazer R Edelman, Farhad R Nezami
Formato:	article
Lenguaje:	EN
Publicado:	Public Library of Science (PLoS) 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/e1430077fdeb4b6dbe8db8d48cdc7be2
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spelling	oai:doaj.org-article:e1430077fdeb4b6dbe8db8d48cdc7be22021-11-25T05:54:15ZUnderstanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study.1932-620310.1371/journal.pone.0251579https://doaj.org/article/e1430077fdeb4b6dbe8db8d48cdc7be22021-01-01T00:00:00Zhttps://doi.org/10.1371/journal.pone.0251579https://doaj.org/toc/1932-6203The bicuspid aortic valve (BAV) is a common and heterogeneous congenital heart abnormality that is often complicated by aortic stenosis. Although initially developed for tricuspid aortic valves (TAV), transcatheter aortic valve replacement (TAVR) devices are increasingly applied to the treatment of BAV stenosis. It is known that patient-device relationship between TAVR and BAV are not equivalent to those observed in TAV but the nature of these differences are not well understood. We sought to better understand the patient-device relationships between TAVR devices and the two most common morphologies of BAV. We performed finite element simulation of TAVR deployment into three cases of idealized aortic anatomies (TAV, Sievers 0 BAV, Sievers 1 BAV), derived from patient-specific measurements. Valve leaflet von Mises stress at the aortic commissures differed by valve configuration over a ten-fold range (TAV: 0.55 MPa, Sievers 0: 6.64 MPa, and Sievers 1: 4.19 MPa). First principle stress on the aortic wall was greater in Sievers 1 (0.316 MPa) and Sievers 0 BAV (0.137 MPa) compared to TAV (0.056 MPa). TAVR placement in Sievers 1 BAV demonstrated significant device asymmetric alignment, with 1.09 mm of displacement between the center of the device measured at the annulus and at the leaflet free edge. This orifice displacement was marginal in TAV (0.33 mm) and even lower in Sievers 0 BAV (0.23 mm). BAV TAVR, depending on the subtype involved, may encounter disparate combinations of device under expansion and asymmetry compared to TAV deployment. Understanding the impacts of BAV morphology on patient-device relationships can help improve device selection, patient eligibility, and the overall safety of TAVR in BAV.Jonathan KusnerGiulia LuraghiFarhan KhodaeeJosé Félix Rodriguez MatasFrancesco MigliavaccaElazer R EdelmanFarhad R NezamiPublic Library of Science (PLoS)articleMedicineRScienceQENPLoS ONE, Vol 16, Iss 5, p e0251579 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Jonathan Kusner Giulia Luraghi Farhan Khodaee José Félix Rodriguez Matas Francesco Migliavacca Elazer R Edelman Farhad R Nezami Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study.
description	The bicuspid aortic valve (BAV) is a common and heterogeneous congenital heart abnormality that is often complicated by aortic stenosis. Although initially developed for tricuspid aortic valves (TAV), transcatheter aortic valve replacement (TAVR) devices are increasingly applied to the treatment of BAV stenosis. It is known that patient-device relationship between TAVR and BAV are not equivalent to those observed in TAV but the nature of these differences are not well understood. We sought to better understand the patient-device relationships between TAVR devices and the two most common morphologies of BAV. We performed finite element simulation of TAVR deployment into three cases of idealized aortic anatomies (TAV, Sievers 0 BAV, Sievers 1 BAV), derived from patient-specific measurements. Valve leaflet von Mises stress at the aortic commissures differed by valve configuration over a ten-fold range (TAV: 0.55 MPa, Sievers 0: 6.64 MPa, and Sievers 1: 4.19 MPa). First principle stress on the aortic wall was greater in Sievers 1 (0.316 MPa) and Sievers 0 BAV (0.137 MPa) compared to TAV (0.056 MPa). TAVR placement in Sievers 1 BAV demonstrated significant device asymmetric alignment, with 1.09 mm of displacement between the center of the device measured at the annulus and at the leaflet free edge. This orifice displacement was marginal in TAV (0.33 mm) and even lower in Sievers 0 BAV (0.23 mm). BAV TAVR, depending on the subtype involved, may encounter disparate combinations of device under expansion and asymmetry compared to TAV deployment. Understanding the impacts of BAV morphology on patient-device relationships can help improve device selection, patient eligibility, and the overall safety of TAVR in BAV.
format	article
author	Jonathan Kusner Giulia Luraghi Farhan Khodaee José Félix Rodriguez Matas Francesco Migliavacca Elazer R Edelman Farhad R Nezami
author_facet	Jonathan Kusner Giulia Luraghi Farhan Khodaee José Félix Rodriguez Matas Francesco Migliavacca Elazer R Edelman Farhad R Nezami
author_sort	Jonathan Kusner
title	Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study.
title_short	Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study.
title_full	Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study.
title_fullStr	Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study.
title_full_unstemmed	Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study.
title_sort	understanding tavr device expansion as it relates to morphology of the bicuspid aortic valve: a simulation study.
publisher	Public Library of Science (PLoS)
publishDate	2021
url	https://doaj.org/article/e1430077fdeb4b6dbe8db8d48cdc7be2
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Understanding TAVR device expansion as it relates to morphology of the bicuspid aortic valve: A simulation study.

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