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分析原生主动脉瓣、患者特异性大村手术和生物瓣的流固耦合机制。

Analysis of Fluid-Structure Interaction Mechanisms for a Native Aortic Valve, Patient-Specific Ozaki Procedure, and a Bioprosthetic Valve.

机构信息

Aix Marseille Univ, CNRS, Centrale Med, M2P2, Marseille, France.

Department of Cardiac Surgery, La Timone Hospital, APHM, Aix Marseille Univ, Marseille, France.

出版信息

Ann Biomed Eng. 2024 Nov;52(11):3021-3036. doi: 10.1007/s10439-024-03566-1. Epub 2024 Sep 3.

DOI:10.1007/s10439-024-03566-1
PMID:39225853
Abstract

The Ozaki procedure is a surgical technique which avoids to implant foreign aortic valve prostheses in human heart, using the patient's own pericardium. Although this approach has well-identified benefits, it is still a topic of debate in the cardiac surgical community, which prevents its larger use to treat valve pathologies. This is linked to the actual lack of knowledge regarding the dynamics of tissue deformations and surrounding blood flow for this autograft pericardial valve. So far, there is no numerical study examining the coupling between the blood flow characteristics and the Ozaki leaflets dynamics. To fill this gap, we propose here a comprehensive comparison of various performance criteria between a healthy native valve, its pericardium-based counterpart, and a bioprosthetic solution, this is done using a three-dimensional fluid-structure interaction solver. Our findings reveal similar physiological dynamics between the valves but with the emergence of fluttering for the Ozaki leaflets and higher velocity and wall shear stress for the bioprosthetic heart valve.

摘要

大崎手术是一种避免将人工主动脉瓣膜植入人体心脏的外科技术,而是使用患者自身的心包膜。尽管这种方法具有明显的优势,但它仍然是心脏外科学术界争论的话题,这阻碍了其更大规模地用于治疗瓣膜病变。这与目前对这种自体心包瓣组织变形和周围血流动力学的实际知识缺乏有关。到目前为止,还没有关于血流特征与大崎瓣叶动力学之间耦合的数值研究。为了填补这一空白,我们在这里使用三维流固耦合求解器对健康的原生瓣膜、基于心包的对应瓣膜和生物假体瓣膜之间的各种性能标准进行了全面比较。我们的研究结果表明,瓣膜之间存在相似的生理动力学,但大崎瓣叶出现了飘动,生物假体心脏瓣膜的速度和壁面剪切应力更高。

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本文引用的文献

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Three-dimensional modelling of aortic leaflet coaptation and load-bearing surfaces: in silico design of aortic valve neocuspidizations.主动脉瓣叶对合及承重表面的三维建模:主动脉瓣新瓣叶化的计算机模拟设计
Interdiscip Cardiovasc Thorac Surg. 2024 Jul 3;39(1). doi: 10.1093/icvts/ivae108.
2
On the role of aortic valve architecture for physiological hemodynamics and valve replacement, Part I: Flow configuration and vortex dynamics.主动脉瓣结构在生理性血流动力学及瓣膜置换中的作用,第一部分:血流形态与涡旋动力学
Comput Biol Med. 2024 Jun;176:108526. doi: 10.1016/j.compbiomed.2024.108526. Epub 2024 May 3.
3
Validation of orthopedic allograft preparation process: a new application of media fill test.
验证矫形移植物制备过程:媒体灌装试验的新应用。
Cell Tissue Bank. 2024 Jun;25(2):521-528. doi: 10.1007/s10561-023-10107-y. Epub 2023 Sep 20.
4
Does the AVNeo valve reduce wall stress on the aortic wall? A cardiac magnetic resonance analysis with 4D-flow for the evaluation of aortic valve replacement with the Ozaki technique.AVNeo瓣膜是否能减轻主动脉壁的壁应力?一项使用4D血流心脏磁共振分析评估Ozaki技术主动脉瓣置换术的研究。
Eur J Cardiothorac Surg. 2023 Dec 1;64(6). doi: 10.1093/ejcts/ezad299.
5
Understanding aortic valve repair through Ozaki procedure: A review of literature evidence.通过小崎手术理解主动脉瓣修复:文献证据综述
J Card Surg. 2022 Dec;37(12):5202-5206. doi: 10.1111/jocs.16846. Epub 2022 Sep 23.
6
Commentary: Leaflet fluttering of bioprosthetic valve-Does it matter?评论:生物瓣膜的瓣叶扑动——有关系吗?
JTCVS Open. 2020 Nov 16;6:82-83. doi: 10.1016/j.xjon.2020.10.009. eCollection 2021 Jun.
7
Ex vivo evaluation of the Ozaki procedure in comparison with the native aortic valve and prosthetic valves.奥扎基手术与天然主动脉瓣和人工瓣膜的离体评估比较。
Interact Cardiovasc Thorac Surg. 2022 Aug 3;35(3). doi: 10.1093/icvts/ivac199.
8
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JTCVS Open. 2021 Jun;6:60-81. doi: 10.1016/j.xjon.2020.09.002. Epub 2020 Sep 21.
9
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Nat Med. 2022 Feb;28(2):283-294. doi: 10.1038/s41591-022-01682-w. Epub 2022 Feb 17.
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