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Patient-specific simulations of transcatheter aortic valve stent implantation

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Abstract

Transcatheter aortic valve implantation (TAVI) enables treatment of aortic stenosis with no need for open heart surgery. According to current guidelines, only patients considered at high surgical risk can be treated with TAVI. In this study, patient-specific analyses were performed to explore the feasibility of TAVI in morphologies, which are currently borderline cases for a percutaneous approach. Five patients were recruited: four patients with failed bioprosthetic aortic valves (stenosis) and one patient with an incompetent, native aortic valve. Three-dimensional models of the implantation sites were reconstructed from computed tomography images. Within these realistic geometries, TAVI with an Edwards Sapien stent was simulated using finite element (FE) modelling. Engineering and clinical outcomes were assessed. In all patients, FE analysis proved that TAVI was morphologically feasible. After the implantation, stress distribution showed no risks of immediate device failure and geometric orifice areas increased with low risk of obstruction of the coronary arteries. Maximum principal stresses in the arterial walls were higher in the model with native outflow tract. FE analyses can both refine patient selection and characterise device mechanical performance in TAVI, overall impacting on procedural safety in the early introduction of percutaneous heart valve devices in new patient populations.

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Acknowledgments

CC is funded by the British Heart Foundation. TO is funded by the EU Marie Currie Intra European Fellowship within the 7th European Community Framework Programme. AMT is funded by the UK National Institute for Child Health, the UK Department of Health, Siemens Medical Solutions and the Fondation Leducq. SS is funded by the Royal Academy of Engineering/EPSRC.

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Authors and Affiliations

  1. Centre for Cardiovascular Imaging, UCL Institute of Cardiovascular Science, Great Ormond Street Hospital for Children, Great Ormond Street, London, WC1N 3JH, UK

    C. Capelli, G. M. Bosi, E. Cerri, T. Odenwald, P. Bonhoeffer, A. M. Taylor & S. Schievano

  2. Laboratory of Biological Structure Mechanics, Structural Engineering Department, Politecnico di Milano, Milan, Italy

    G. M. Bosi, E. Cerri & F. Migliavacca

  3. Department of Congenital Heart Disease and Paediatric Cardiology, Deutsches Herzzentrum Berlin, Berlin, Germany

    J. Nordmeyer

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  1. C. Capelli
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  2. G. M. Bosi
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  3. E. Cerri
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  4. J. Nordmeyer
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  5. T. Odenwald
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  6. P. Bonhoeffer
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  7. F. Migliavacca
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  8. A. M. Taylor
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  9. S. Schievano
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Correspondence to C. Capelli.

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C. Capelli and G. M. Bosi contributed equally to this publication.

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Capelli, C., Bosi, G.M., Cerri, E. et al. Patient-specific simulations of transcatheter aortic valve stent implantation. Med Biol Eng Comput 50, 183–192 (2012). https://doi.org/10.1007/s11517-012-0864-1

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  • DOI: https://doi.org/10.1007/s11517-012-0864-1

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