经导管主动脉瓣置换术中导管跟踪导致血管损伤的计算研究。

Computational Investigation of Vessel Injury Due to Catheter Tracking During Transcatheter Aortic Valve Replacement.

机构信息

Biomedical Engineering, School of Engineering, College of Science and Engineering, University of Galway, Galway, Ireland.

Department of Anatomy and Regenerative Medicine, Royal College of Surgeons in Ireland (RCSI), Dublin, Ireland.

出版信息

Ann Biomed Eng. 2024 Jun;52(6):1554-1567. doi: 10.1007/s10439-024-03462-8. Epub 2024 Apr 8.

Abstract

Catheter reaction forces during transcatheter valve replacement (TAVR) may result in injury to the vessel or plaque rupture, triggering distal embolization or thrombosis. In vitro test methods represent the arterial wall using synthetic proxies to determine catheter reaction forces during tracking, but whether they can account for reaction forces within the compliant aortic wall tissue in vivo is unknown. Moreover, the role of plaque inclusions is not well understood. Computational approaches have predicted the impact of TAVR positioning, migration, and leaflet distortion, but have not yet been applied to investigate aortic wall reaction forces and stresses during catheter tracking. In this study, we investigate the role that catheter design and aorta and plaque mechanical properties have on the risk of plaque rupture during TAVR catheter delivery. We report that, for trackability testing, a rigid test model provides a reasonable estimation of the peak reaction forces experienced during catheter tracking within compliant vessels. We investigated the risk of rupture of both the aortic tissue and calcified plaques. We report that there was no risk of diseased aortic tissue rupture based on an accepted aortic tissue stress threshold (4.2 MPa). However, we report that both the aortic and plaque tissue exceed a rupture stress threshold (300 kPa) with and without the presence of stiff and soft plaque inclusions. We also highlight the potential risks associated with shorter catheter tips during catheter tracking and demonstrate that increasing the contact surface will reduce peak contact pressures experienced in the tissue.

摘要

经导管瓣膜置换术(TAVR)过程中导管的反作用力可能导致血管损伤或斑块破裂,引发远端栓塞或血栓形成。体外测试方法使用合成代理物来模拟动脉壁,以确定在跟踪过程中导管的反作用力,但它们是否能反映体内顺应性主动脉壁组织内的反作用力尚不清楚。此外,斑块内含物的作用也不明确。计算方法已经预测了 TAVR 定位、迁移和瓣叶变形的影响,但尚未应用于研究导管跟踪过程中主动脉壁的反作用力和应力。在这项研究中,我们研究了导管设计以及主动脉和斑块力学特性对 TAVR 导管输送过程中斑块破裂风险的影响。我们报告说,对于可跟踪性测试,刚性测试模型可以合理估计在顺应性血管内导管跟踪过程中经历的峰值反作用力。我们研究了主动脉组织和钙化斑块破裂的风险。我们报告说,根据公认的主动脉组织应力阈值(4.2 MPa),不会有病变的主动脉组织破裂的风险。然而,我们报告说,在存在硬斑块和软斑块内含物的情况下,主动脉和斑块组织的破裂应力阈值(300 kPa)都会超过。我们还强调了在导管跟踪过程中短导管尖端可能带来的潜在风险,并表明增加接触面积将减少组织中经历的峰值接触压力。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/be1d/11082034/4b7309d79d4f/10439_2024_3462_Fig1_HTML.jpg

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