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Blood Stasis on Transcatheter Valve Leaflets and Implications for Valve-in-Valve Leaflet Thrombosis

Koohyar Vahidkhah1, Shahnaz Javani1, Mostafa Abbasi1

  • 1The DU Cardiovascular Biomechanics Laboratory, University of Denver, Denver, Colorado.

The Annals of Thoracic Surgery
|May 10, 2017
PubMed

Insights

Transcatheter aortic valve (TAV) thrombosis after valve-in-valve (ViV) procedures is linked to increased blood residence time (BRT) on leaflets compared to surgical aortic valves (SAV). This prolonged BRT, especially on TAV leaflets, may promote leaflet thrombosis.

Area of Science:

  • Cardiovascular research
  • Biomedical engineering
  • Fluid dynamics

Background:

  • Leaflet thrombosis is a growing concern following valve-in-valve (ViV) procedures.
  • Understanding the hemodynamic factors contributing to thrombosis is crucial for improving patient outcomes.

Purpose of the Study:

  • To investigate the role of blood flow dynamics in leaflet thrombosis after ViV procedures.
  • To compare blood stasis on surgical aortic valve (SAV) and transcatheter aortic valve (TAV) leaflets in a ViV setting.

Main Methods:

  • Developed patient-specific computational models for SAV and TAV in ViV configurations.
  • Utilized fluid-solid interaction modeling to simulate 3D flow fields.
  • Quantified blood residence time (BRT) on coronary and noncoronary leaflets.

Main Results:

  • Transcatheter aortic valve (TAV) leaflets exhibited significantly longer blood residence time (BRT) compared to surgical aortic valves (SAV), particularly near leaflet fixation points.
  • Areas of high BRT (≥1.2 seconds) on TAV leaflets were four times larger than on SAV leaflets at end-diastole.
  • SAV models showed high BRT predominantly on noncoronary leaflets, while TAV models displayed a more uniform distribution across all leaflets.

Conclusions:

  • Increased BRT on TAV leaflets, caused by geometric confinement within the degenerated bioprosthesis, is a potential factor promoting leaflet thrombosis after ViV.
  • The uniform BRT distribution on TAV leaflets may explain the similar thrombosis rates observed across all three leaflets.
Abstract

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