Nappi Francesco, Mazzocchi Laura, Spadaccio Cristiano, Attias David, Timofeva Irina, Macron Laurent, Iervolino Adelaide, Morganti Simone, Auricchio Ferdinando
Department of Cardiac Surgery, Centre Cardiologique du Nord, 93200 Saint Denis, France.
Department of Civil Engineering and Architecture, University of Pavia, 27100 Pavia, Italy.
Bioengineering (Basel). 2021 Apr 27;8(5):52. doi: 10.3390/bioengineering8050052.
to investigate the factors implied in the development of postoperative complications in both self-expandable and balloon-expandable transcatheter heart valves by means of finite element analysis (FEA).
FEA was integrated into CT scans to investigate two cases of postoperative device failure for valve thrombosis after the successful implantation of a CoreValve and a Sapien 3 valve. Data were then compared with two patients who had undergone uncomplicated transcatheter heart valve replacement (TAVR) with the same types of valves.
Computational biomechanical modeling showed calcifications persisting after device expansion, not visible on the CT scan. These calcifications determined geometrical distortion and elliptical deformation of the valve predisposing to hemodynamic disturbances and potential thrombosis. Increased regional stress was also identified in correspondence to the areas of distortion with the associated paravalvular leak.
the use of FEA as an adjunct to preoperative imaging might assist patient selection and procedure planning as well as help in the detection and prevention of TAVR complications.
通过有限元分析（FEA）研究自膨胀式和球囊扩张式经导管心脏瓣膜术后并发症发生发展的相关因素。
将有限元分析整合到CT扫描中，研究成功植入CoreValve和Sapien 3瓣膜后两例因瓣膜血栓形成导致术后装置故障的病例。然后将数据与另外两名接受相同类型瓣膜的无并发症经导管心脏瓣膜置换术（TAVR）患者进行比较。
计算生物力学建模显示装置扩张后钙化持续存在，这在CT扫描上不可见。这些钙化导致瓣膜几何形状扭曲和椭圆形变形，易引发血流动力学紊乱和潜在血栓形成。在伴有瓣周漏的扭曲区域还发现局部应力增加。
使用有限元分析作为术前成像的辅助手段，可能有助于患者选择和手术规划，以及帮助检测和预防经导管主动脉瓣置换术并发症。
