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Prosthetic venous valve patient selection by validated physics-based computational models.

Henry Y Chen¹, Zachary C Berwick², Arika Kemp³

¹Department of Biomedical Engineering, IUPUI, Indianapolis, Ind; The California Medical Innovations Institute, Inc, San Diego, Calif; Department of Cellular and Integrative Physiology, Indiana University School of Medicine, Indianapolis, Ind.

Journal of Vascular Surgery. Venous and Lymphatic Disorders

|March 20, 2016

Summary

This summary is machine-generated.

A new study suggests venous valve prostheses are most beneficial for patients with severe chronic venous insufficiency (CVI), right heart hypertrophy (RHH), or right heart failure (RHF). These devices are less effective for deep venous thrombosis (DVT) patients with low flow.

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Area of Science:

Biomedical Engineering
Cardiovascular Research
Computational Fluid Dynamics

Background:

Venous valve prostheses are being developed to address insufficient valves.
Patient selection is crucial for optimal outcomes with these devices.
Hemodynamic factors significantly influence the efficacy of venous valve prostheses.

Purpose of the Study:

To identify patient groups most likely to benefit from venous valve implants.
To test the hypothesis that prostheses are most suitable for patients with significant reflux (CVI, RHH, RHF) and least suitable for low-flow DVT patients.

Main Methods:

Developed and validated coupled fluid-solid mechanics computational models in canine implants.
Applied validated models to simulate hemodynamic conditions in patients with CVI, RHH, RHF, and DVT using literature data.
Defined a mechanical stress ratio to assess leaflet function, with lower ratios being hemodynamically desirable.

Main Results:

Simulation accuracy was within 10% of canine implant measurements for valve flow velocity and opening.
Patients with CVI (classes 4-6), RHH, and RHF showed potential for significant stress ratio reduction with prosthetic valves.
DVT patients demonstrated minimal stress ratio reduction, but prostheses may benefit post-thrombotic patients after flow restoration.

Conclusions:

Venous valve prostheses are most suitable for patients with CVI (classes 4-6), RHH, and RHF.
Prosthetic valves are less effective for DVT patients due to low-flow conditions.
This study offers a physics-based approach for patient selection, warranting future clinical validation.