评估TAVR后的心脏导电异常风险使用电机械合的跳动心脏
Symon Reza1, Brandon Kovarovic1, Danny Bluestein2
1Department of Biomedical Engineering, Stony Brook University, Stony Brook, NY, 11794-8084, USA.
Biomechanics and modeling in mechanobiology
|October 3, 2024
概括
透气管大动脉置换 (TAVR) 可能会导致心脏导电异常 (CCA) 由于设备对心脏纤维施加压力. 更深层的植入和右捆分支堵塞增加了CCA风险,而大动脉部署和左捆分支堵塞可能会减少它.
科学领域:
- 心血管医学 心血管医学
- 生物医学工程 生物医学工程
- 计算建模计算建模
背景情况:
- 越来越多的人更喜欢通过导管的大动脉置换 (TAVR),而不是手术大动脉置换 (SAVR).
- 心脏导电异常 (CCA) 是TAVR后的一个重大并发症.
- 来自TAVR装置对心脏导电纤维在心房节附近的压力可以导致CCA.
研究的目的:
- 在TAVR之后开发一个in silico框架来评估CCA风险.
- 调查植入深度和先前存在的心脏异步对CCA的影响.
- 分析影响TAVR后CCA的生物力学参数.
主要方法:
- 模拟自扩展TAVR设备部署在电机械合的跳动心脏模型中.
- 模拟了五个患者场景,植入深度和先前存在的疾病 (RBBB,LBBB) 不同.
- 分析了传导纤维上的累积接触压力.
主要成果:
- 与心室部署 (0.52 MPa) 相比,大动脉TAVR部署导致接触压力较低 (0.018 MPa).
- 之前存在的右束分支块 (RBBB) 显示了比左束分支块 (LBBB) (0.25 MPa) 更高的接触压力 (0.34 MPa).
- 更深的植入和RBBB增加了传导纤维的应力和接触压力.
结论:
- 更深的TAVR植入和RBBB增加了TAVR后CCA的风险.
- 大动脉部署和LBBB可以降低CCA的风险.
- 在模型提供了一个有价值的工具,用于预测和减轻TAVR相关的导电并发症.
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