The Journal of Thoracic and Cardiovascular Surgery
Adult: Aortic Valve: Evolving TechnologyEffect of leaflet laceration on transcatheter aortic valve replacement fluid mechanics and comparison with surgical aortic valve replacement
Graphical abstract
Section snippets
In Vitro Flow Loop
To characterize the fluid mechanics of TAVR and SAVR, a validated pulsatile left heart flow simulator with coronary flow modeling capability12 was utilized. To be able to have optical access to the model, a fluid with the same viscosity as blood was used, which consisted of a water-glycerin solution with 36% glycerin by volume. A previously utilized model of the aortic root with 3 sinuses, based on post-TAVR averaged human aortic root dimensions12 was present. To simplify the model, only 1
Summary of Flow Experiments
Figure 4 shows a bar graph summary of the results of the different flow experiments when imaging the native sinus regions for the simulated SAVR and TAVR scenarios. With increasing leaflet laceration or leaflet removal, the average sinus velocities continued to increase. The SAVR model had the highest average sinus velocities and was used to normalize the results. Velocities in the LCC were higher than the NCC for all conditions, except with single leaflet laceration of the NCC. Figure 5 shows
Discussion
In this in vitro study of fluid mechanics in the native and neosinus regions following SAVR and TAVR, we observed the following: SAVR provided the highest flow in both the native- and neosinus regions; in the setting of TAVR, modifying any native leaflet improved flow in both the sinus and neosinus regions, even in the cusps without lacerated leaflets; with an increasing number of modified leaflets, there was a stepwise improvement in flow in all sinus and neosinus regions measured; and there
Conclusions
Aortic leaflet laceration and removal augmented TAVR native- and neosinus flow velocities, approaching that of SAVR. Dedicated devices to facilitate leaflet modification and clinical trials that study their role in preventing leaflet thrombosis may influence lifetime valve management.
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