Early Detection of Risk of Neo-Sinus Blood Stasis Post-Transcatheter Aortic Valve Replacement Using Personalized...

Area of Science:

• Cardiovascular Imaging and Fluid Dynamics
• Computational Biology and Biomechanics
• Interventional Cardiology

Background:

• Transcatheter aortic valve replacement (TAVR) is beneficial but associated with subclinical leaflet thrombosis and hypoattenuated leaflet thickening, indicating reduced durability and increased stroke risk.
• These findings suggest potential long-term complications impacting valve performance and patient outcomes.

Purpose of the Study:

• To develop and utilize a patient-specific computational framework to assess the hemodynamic and functional consequences of TAVR.
• To quantify global circulatory and cardiac function, as well as local fluid dynamics in the aortic root and coronary arteries post-TAVR.

Main Methods:

• Development of a multiscale, patient-specific computational framework.
• Quantification of global circulatory and cardiac function metrics.
• Analysis of local cardiac fluid dynamics within the aortic root and coronary arteries.

Main Results:

• TAVR was associated with significant blood stagnation in the neo-sinus region, with increased blood stasis volume in all three cusps.
• In some patients, TAVR did not lead to substantial left ventricle load relief or improved diastolic coronary flow.
• Specific reductions in coronary flow were observed in the left anterior descending, left circumflex, and right coronary arteries.

Conclusions:

• Amelioration of the transvalvular pressure gradient post-TAVR may not guarantee adequate sinus blood washout, optimal coronary flow, or reduced cardiac stress.
• Noninvasive personalized computational modeling offers a valuable tool for pre-TAVR strategy optimization and post-TAVR complication monitoring (leaflet thrombosis, coronary plaque).