Author + information
- Amirsepehr Azimian,
- Scott Lilly,
- Jennifer Dollery,
- Juan Crestanello and
- Lakshmi Prasad Dasi
Paravalvular Leakage (PVL) is a serious complication after transcatheter aortic valve replacement (TAVR)(1). In the present study two clinically approved devices, CoreValve and SAPIEN 3 (Figure 1A), were computationally implanted in a patient’s aortic root to predict the likelihood of PVL.
To study the role of valve selection on PVL, the 3D geometry of a 84 year-old male patient from pre-procedural CT images was reconstructed. Each valve was then implanted in the patient’s aortic root and the final deformation of native leaflets and stents were simulated. To capture diastolic PVL, 100 mmHg diastolic pressure was applied for 0.66 seconds and PVL was quantified using flow rate, flow resistance, number of leakage jets, and maximum jet velocity. Finally, the CoreValve simulation was validated against in-vivo echocardiographic color Doppler measurements (Figure 1B).
Results and Conclusion
The patient was treated clinically using a 34 mm CoreValve and was then diagnosed with severe PVL secondary to calcification in LVOT during 1 month follow-up. Computational models showed three leakage jets of PVL with the maximum velocity of 5 m/s in the presence of 34 mm CoreValve with good agreement with Doppler measurements However, only one jet with the maximum velocity of 4.1 m/s was observed with a simulated 29 mm SAPIEN 3 implantation. PVL flow rate significantly reduced from 4.94 L/min with CoreValve to 2.65 L/min for SAPIEN 3 (Figure 1C). This noticeable reduction in the PVL flow was the consequence of SAPIEN 3 design and expansion, which better seals the leakage gap in comparison with CoreValve (Figure 1D). This study is an illustrative proof of concept that patient-specific pre-procedural planning regarding valve selection can be improved by personalized computational modeling.
1. Mack MJ, et al.The Lancet 2015;385:2477-2484.