Laboratory of Biological Structure Mechanics, Department of Chemistry, Materials and Chemical Engineering 'Giulio Natta, Politecnico di Milano , Milan, Italy.
Expert Rev Cardiovasc Ther. 2021 Jan;19(1):61-70. doi: 10.1080/14779072.2021.1850265. Epub 2020 Dec 31.
: Increasing applications of transcatheter aortic valve replacement (TAVR) to treat high- or medium-risk patients with aortic diseases have been proposed in recent years. Despite its increasing use, many influential factors are still to be understood. Furthermore, innovative applications of TAVR such as in bicuspid aortic valves or in low-risk patients are emerging in clinical use. Numerical analyses are increasingly used to reproduce clinical treatments. The future trends in this area are foreseen for in silico trials and personalized medicine. : This review paper analyzes the recent years (Jan 2018 - Aug 2020) of in silico studies simulating the behavior of transcatheter aortic valves with emphasis on the addressed clinical question and the used modeling strategies. The manuscripts are firstly classified based on their clinical hypothesis. A second classification is based on the adopted modeling approach in terms of patient domain, device modeling, and inclusion or exclusion of the fluid domain. : The TAVR can be virtually performed in numerous vessel geometries and with different devices. This versatility allows a rapid evaluation of the feasibility of different implantation approaches for specific patients, and patient populations, resulting in faster and safer introduction or optimization of new treatments or devices.
近年来,越来越多的经导管主动脉瓣置换术(TAVR)被应用于治疗高危或中危主动脉疾病患者。尽管 TAVR 的应用越来越广泛,但仍有许多影响因素尚待了解。此外,TAVR 在临床上的创新应用,如在二叶式主动脉瓣或低危患者中的应用,也正在出现。数值分析越来越多地用于复制临床治疗。该领域的未来趋势是计算机模拟试验和个性化医学。
本文综述了近(2018 年 1 月至 2020 年 8 月)来计算机模拟经导管主动脉瓣行为的研究,重点分析了所涉及的临床问题和所采用的建模策略。这些文献首先根据其临床假设进行分类。其次是根据所采用的建模方法,根据患者领域、设备建模、以及是否包含或排除流体域进行分类。
TAVR 可以在无数的血管几何形状和不同的设备中进行虚拟操作。这种多功能性允许快速评估不同植入方法对特定患者和患者群体的可行性,从而更快、更安全地引入或优化新的治疗方法或设备。