Related Experiment Video
Updated: Jun 9, 2025
Particle Image Velocimetry Investigation of Hemodynamics via Aortic Phantom
Published on: February 25, 2022
Native Sinus Hemodynamics and Thrombosis in Transcatheter Heart Valve: Effect of Implant Depth and Coronary Flow
Hyun Jung Koo1, Jihun Kang2, Do-Yoon Kang3
1Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center University of Ulsan College of Medicine, Asan Medical Center Seoul South Korea.
Insights
Transcatheter aortic valve replacement (TAVR) can lead to sinus thrombosis, particularly with self-expanding valves. Implant depth and sinus anatomy are key risk factors for this complication.
Area of Science:
- Cardiovascular Medicine
- Biomedical Engineering
- Interventional Cardiology
Background:
- Native sinus thrombosis is a potential complication following transcatheter aortic valve replacement (TAVR).
- Understanding the factors contributing to sinus thrombosis is crucial for improving TAVR outcomes.
Purpose of the Study:
- To investigate the hemodynamic and anatomic factors associated with native sinus thrombosis after TAVR.
- To integrate in vivo patient data with in vitro experimental findings.
Main Methods:
- Analysis of 4D CT data from 211 patients in the ADAPT-TAVR study.
- In vitro particle image velocimetry experiments to assess sinus flow dynamics with different valve types and positioning.
- Examination of correlations between native sinus thrombosis and valve type, implant depth, and sinus anatomy.
Main Results:
- Native sinus thrombosis was more prevalent with self-expanding valves (39.1%) compared to balloon-expandable valves (14.9%).
- Significant factors associated with thrombosis included higher implant depth, noncoronary sinus of Valsalva, smaller sinus inflow diameter, and larger implanted valve size.
- In vitro studies showed flow stasis with CoreValve and reduced sinus velocity with high-positioned SAPIEN3 valves. Coronary artery flow improved sinus velocity and particle washout.
Conclusions:
- Transcatheter heart valve deployment characteristics significantly influence native sinus thrombosis risk.
- Anatomic factors of the aortic sinus and valve implantation parameters play a critical role in the development of sinus thrombosis post-TAVR.
Background:
This study aimed to investigate the hemodynamic and anatomic factors associated with sinus thrombosis following transcatheter aortic valve replacement (TAVR), integrating in vivo patient data analysis and in vitro experiments.
Methods And Results:
Postprocedural, 4-dimensional, multiphase computed tomography data from 211 patients enrolled in the ADAPT-TAVR (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement) study were analyzed. The prevalence of native sinus thrombosis was examined in relation to valve type, implant depth, and anatomic features. In vitro experiments used particle image velocimetry to observe changes in sinus flow based on the transcatheter heart valves (23-mm SAPIEN3, Edwards Lifesciences; and 29-mm CoreValve, Medtronic) height and coronary artery flow. Native sinus thrombosis was more common in self-expanding valves (39.1% versus 14.9%, P=0.004). In per-cusp analysis of in vivo patient data, adjusted transcatheter heart valve implant depth (odds ratio, 1.2 [95% CI, 1.1-1.3]; P<0.001), noncoronary sinus of Valsalva (odds ratio, 4.0 [95% CI, 2.0-7.8]; P<0.001), sinus inflow diameter (odds ratio, 0.8 [95% CI, 0.6-0.9]; P=0.008), and implanted valve size (odds ratio, 0.8 [95% CI, 0.7-1.0]; P=0.025) were significant factors associated with native sinus thrombosis. In the in vitro experiments, CoreValve showed noticeable flow stasis compared with SAPIEN3. High-positioned SAPIEN3 was linked to reduced velocity within the native sinus of Valsalva. Coronary artery flow led to higher sinus velocity and improved particle washout, reducing sinus thrombosis risk.
Conclusions:
This study provides insights into the relationship between transcatheter heart valve deployment and native sinus thrombosis, emphasizing the role of anatomic factors in relation to the risk of sinus thrombosis.
