Khodaei Seyedvahid, Abdelkhalek Mohamed, Maftoon Nima, Emadi Ali, Keshavarz-Motamed Zahra
Department of Mechanical Engineering, McMaster University, Hamilton, Ontario, Canada.
School of Biomedical Engineering, McMaster University, Hamilton, Ontario, Canada.
Struct Heart. 2023 Apr 28;7(5):100180. doi: 10.1016/j.shj.2023.100180. eCollection 2023 Sep.
Despite the demonstrated benefits of transcatheter aortic valve replacement (TAVR), subclinical leaflet thrombosis and hypoattenuated leaflet thickening are commonly seen as initial indications of decreased valve durability and augmented risk of transient ischemic attack.
We developed a multiscale patient-specific computational framework to quantify metrics of global circulatory function, metrics of global cardiac function, and local cardiac fluid dynamics of the aortic root and coronary arteries.
Based on our findings, TAVR might be associated with a high risk of blood stagnation in the neo-sinus region due to the lack of sufficient blood flow washout during the diastole phase (e.g., maximum blood stasis volume increased by 13, 8, and 2.7 fold in the left coronary cusp, right coronary cusp, and noncoronary cusp, respectively [N = 26]). Moreover, in some patients, TAVR might not be associated with left ventricle load relief (e.g., left ventricle load reduced only by 1.2 % [N = 26]) and diastolic coronary flow improvement (e.g., maximum coronary flow reduced by 4.94%, 15.05%, and 23.59% in the left anterior descending, left circumflex coronary artery, and right coronary artery, respectively, [N = 26]).
The transvalvular pressure gradient amelioration after TAVR might not translate into adequate sinus blood washout, optimal coronary flow, and reduced cardiac stress. Noninvasive personalized computational modeling can facilitate the determination of the most effective revascularization strategy pre-TAVR and monitor leaflet thrombosis and coronary plaque progression post-TAVR.
尽管经导管主动脉瓣置换术（TAVR）已显示出诸多益处，但亚临床瓣叶血栓形成和瓣叶低密度增厚通常被视为瓣膜耐久性下降和短暂性脑缺血发作风险增加的初始迹象。
我们开发了一种多尺度的患者特异性计算框架，以量化整体循环功能指标、整体心脏功能指标以及主动脉根部和冠状动脉的局部心脏流体动力学指标。
基于我们的研究结果，TAVR可能与舒张期新窦区域血流淤滞风险较高有关，这是由于舒张期缺乏足够的血流冲刷（例如，左冠状动脉瓣叶、右冠状动脉瓣叶和无冠状动脉瓣叶的最大血液淤滞量分别增加了13倍、8倍和2.7倍 [N = 26]）。此外，在一些患者中，TAVR可能与左心室负荷减轻（例如，左心室负荷仅降低1.2% [N = 26]）和舒张期冠状动脉血流改善无关（例如，左前降支、左旋支冠状动脉和右冠状动脉的最大冠状动脉血流分别降低了4.94%、15.05%和23.59% [N = 26]）。
TAVR术后跨瓣压差的改善可能无法转化为足够的窦部血液冲刷、最佳的冠状动脉血流和减轻的心脏压力。无创个性化计算建模有助于在TAVR术前确定最有效的血运重建策略，并监测TAVR术后瓣叶血栓形成和冠状动脉斑块进展情况。
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