Impact of Leaflet Laceration on Transcatheter Aortic Valve-in-Valve WashoutBASILICA to Solve Neosinus and Sinus Stasis
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click the login link or the subscribe link in the top menu above to access this article.
Author + information
- Hoda Hatoum, PhDa,
- Pablo Maureira, MD, PhDb,
- Scott Lilly, MD, PhDc and
- Lakshmi Prasad Dasi, PhDa,∗ (lakshmi.dasi{at}osumc.edu)
- aDepartment of Biomedical Engineering, The Ohio State University, Columbus, Ohio
- bDepartment of Cardiovascular Surgery, CHU de Nancy, Nancy, France
- cDivision of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio
- ↵∗Address for correspondence:
Dr. Lakshmi Prasad Dasi, Department of Biomedical Engineering, The Ohio State University, 473 West 12th Avenue, Columbus, Ohio 43210.
Central Illustration
Abstract
Objectives The aim of this study was to evaluate any potential leaflet washout benefits after bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction during TAVR (BASILICA) in transcatheter valve-in-valve (ViV) in the context of leaflet thrombosis.
Background Leaflet thrombosis after transcatheter aortic valve replacement is secondary to flow stasis in both the sinus and neosinus. Strategies to improve washout and ameliorate neosinus and sinus flow velocities may have the potential to mitigate the occurrence of clinical and subclinical leaflet thrombosis.
Methods A 23-mm Edwards SAPIEN 3 and a 26-mm Medtronic Evolut were deployed in a 23-mm transparent surgical aortic valve model before and after leaflet laceration. The valves were placed in the aortic position of a pulse duplicator flow loop. Particle image velocimetry was performed to quantify sinus flow hemodynamic status. A tracing fluorescent dye was injected to evaluate the number of cycles to washout in both regions of interest.
Results The leaflet laceration procedure led to an increase in the velocities in the sinus and the neosinus by 50% for Evolut ViV and 61.9% for SAPIEN 3 ViV. In addition, leaflet laceration led to a reduction in overall cycles to washout in the neosinus by at least 56% with the Evolut and 54.5% with the SAPIEN 3 and in the sinus by at least 16.7% with the Evolut and 60.8% with the SAPIEN.
Conclusions Leaflet laceration using a BASILICA-type approach may hold the potential to mitigate neosinus and sinus flow stasis. Controlled in vivo trials are necessary to establish the potential benefit of BASILICA to reduce the occurrence of leaflet thrombosis.
Footnotes
This research was partly supported by the National Institutes of Health under award R01HL119824 and the American Heart Association under award 19POST34380804. Dr. Dasi has patent applications filed on novel polymeric valves, vortex generators, and superhydrophobic/omniphobic surfaces. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received December 17, 2018.
- Revision received March 26, 2019.
- Accepted April 9, 2019.
- 2019 American College of Cardiology Foundation
This article requires a subscription or purchase to view the full text. If you are a subscriber or member, click Login or the Subscribe link (top menu above) to access this article.
