Scuoppo Roberta, Cannata Stefano, Gentile Giovanni, Gandolfo Caterina, Pasta Salvatore
Department of Engineering, Università Degli Studi di Palermo, Palermo, Italy.
Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (ISMETT), Palermo, Italy.
Front Bioeng Biotechnol. 2023 Oct 11;11:1267986. doi: 10.3389/fbioe.2023.1267986. eCollection 2023.
Transcatheter aortic valve replacement (TAVR) is increasingly being considered for use in younger patients having longer life expectancy than those who were initially treated. The TAVR-in-TAVR procedure represents an appealing strategy to treat failed transcatheter heart valves (THV) likely occurring in young patients. However, the permanent displacement of first THV can potentially compromise the coronary access and ultimately inhibit the blood flow circulation. The objective of this study was to use finite-element analysis (FEA) to quantify coronary flow in a patient who underwent TAVR-in-TAVR. A parametric investigation was carried out to determine the impact of both the implantation depth and device size on coronary flow for several deployment configurations. The FEAs consisted of first delivering the SAPIEN 3 Ultra THV and then positioning the Evolut PRO device. Findings indicates that high implantation depth and device undersize of the second THV could significantly reduce coronary flow to 20% of its estimated level before TAVR. Additionally, a positive correlation was observed between coronary flow and the valve-to-coronary distance (R = 0.86 and = 0.032 for the left coronary artery, and R = 0.93 and = 0.014 for the right coronary artery). This study demonstrated that computational modeling can provide valuable insights to improve the pre-procedural planning of TAVR-in-TAVR.
对于预期寿命比最初接受治疗的患者更长的年轻患者，经导管主动脉瓣置换术（TAVR）越来越多地被考虑使用。TAVR-in-TAVR手术是一种有吸引力的策略，用于治疗可能发生在年轻患者身上的经导管心脏瓣膜（THV）功能失效。然而，首个THV的永久性移位可能会影响冠状动脉通路，并最终阻碍血液循环。本研究的目的是使用有限元分析（FEA）来量化接受TAVR-in-TAVR手术患者的冠状动脉血流。进行了一项参数研究，以确定植入深度和器械尺寸对几种展开配置下冠状动脉血流的影响。有限元分析包括首先输送SAPIEN 3 Ultra THV，然后定位Evolut PRO器械。研究结果表明，第二个THV的高植入深度和器械尺寸过小会显著降低冠状动脉血流，使其降至TAVR前估计水平的20%。此外，观察到冠状动脉血流与瓣膜到冠状动脉的距离之间存在正相关（左冠状动脉R = 0.86，P = 0.032；右冠状动脉R = 0.93，P = 0.014）。本研究表明，计算建模可为改善TAVR-in-TAVR的术前规划提供有价值的见解。
