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Technique and Patient Selection Criteria of Right Anterior Mini-Thoracotomy for Minimal Access Aortic Valve Replacement
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Reducing Long-Term Mortality Post Transcatheter Aortic Valve Replacement Requires Systemic Differentiation of

Seyedvahid Khodaei1, Louis Garber2, Mohamed Abdelkhalek2

  • 1Department of Mechanical Engineering McMaster University Hamilton Ontario Canada.

Journal of the American Heart Association
|May 26, 2023
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) may adversely affect coronary blood flow and increase heart workload, despite relieving pressure gradients. Personalized computational modeling can help optimize TAVR strategies and monitor coronary artery disease progression.

Area of Science:

  • Cardiovascular Medicine
  • Biomedical Engineering
  • Computational Biology

Background:

  • Transcatheter aortic valve replacement (TAVR) is increasingly used, even in high-risk patients.
  • Coronary artery disease (CAD) frequently coexists with aortic stenosis in TAVR candidates.
  • The long-term effects of TAVR on coronary arteries and cardiac hemodynamics are not fully understood.

Purpose of the Study:

  • To investigate the impact of TAVR on coronary and cardiac hemodynamics using a patient-specific computational model.
  • To assess noninvasively how TAVR affects coronary blood flow, left ventricle workload, and coronary wall shear stress.

Main Methods:

  • Development of a multiscale, patient-specific computational framework.
  • Noninvasive simulation of hemodynamics before and after TAVR.
  • Analysis of coronary flow rates, left ventricle workload, and coronary wall shear stress.

Main Results:

  • TAVR may lead to reduced diastolic coronary blood flow (e.g., maximum flow rate decreased by up to 22.73% in the right coronary artery).
  • Left ventricle workload may increase post-TAVR (by 2.52%).
  • Coronary wall shear stress may decrease across various coronary branches (e.g., up to 9.47% at bifurcations).

Conclusions:

  • Relief of transvalvular pressure gradient post-TAVR may not improve coronary flow or reduce cardiac load.
  • Noninvasive personalized computational modeling can inform pre-TAVR revascularization strategies.
  • This approach may aid in monitoring coronary artery disease progression after TAVR.

Keywords:
cardiac fluid dynamicscoronary hemodynamicsglobal hemodynamicslocal fluid dynamicspatient‐specific lumped parameter modeltranscatheter aortic valve replacement

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