Vol. 23 No. 3 (2019)
ACQUIRED HEART DISEASES

Numerical modelling of redo of the prosthetic heart valve: hemodynamics

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  • E. Ovcharenko,
  • P. Onishchenko,
  • K. Klyshnikov,
  • V. Ganyukov,
  • A. Shilov,
  • I. Vereshchagin,
  • A. Kokov,
  • R. Tarasov,
  • V. Borisov,
  • Yu. Zakharov,
  • L. Barbarash
E. Ovcharenko
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
P. Onishchenko
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
K. Klyshnikov
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
Bio
V. Ganyukov
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
A. Shilov
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
I. Vereshchagin
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
A. Kokov
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
R. Tarasov
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
V. Borisov
Kemerovo State University, Kemerovo, Kemerovo Branch of the Institute of Computational Technologies of the Siberian Branch of the Russian Academy of Sciences, Kemerovo
Yu. Zakharov
Kemerovo State University, Kemerovo, Kemerovo Branch of the Institute of Computational Technologies of the Siberian Branch of the Russian Academy of Sciences, Kemerovo
L. Barbarash
Research Institute for Complex Issues of Cardiovascular Diseases, Kemerovo
DOI: https://doi.org/10.21688/1681-3472-2019-3-30-38

Published 2019-11-27

Keywords

  • bioprosthesis,
  • numerical simulation,
  • paravalvular leakage,
  • redo,
  • transcatheter implantation

How to Cite

Ovcharenko, E., Onishchenko, P., Klyshnikov, K., Ganyukov, V., Shilov, A., Vereshchagin, I., Kokov, A., Tarasov, R., Borisov, V., Zakharov, Y., & Barbarash, L. (2019). Numerical modelling of redo of the prosthetic heart valve: hemodynamics. Patologiya Krovoobrashcheniya I Kardiokhirurgiya, 23(3), 30–38. https://doi.org/10.21688/1681-3472-2019-3-30-38

Copyright (c) 2019 Ovcharenko E. A., Onishchenko P. S., Klyshnikov K. Yu., Ganyukov V. I., Shilov A. A., Vereshchagin I. E., Kokov A. N., Tarasov R. S., Borisov V. G., Zakharov Yu. N., Barbarash L. S.

Creative Commons License

This work is licensed under a Creative Commons Attribution 4.0 International License.

Abstract

Aim. In this article, we report a numerical analysis of the causes and haemodynamic effects of paraprosthetic regurgitation during redo transcatheter prosthesis of the aortic valve with the “valve-in-valve” technique with respect to the predictive value of computer modelling.
Methods. We used numerical analysis of haemodynamics for a patient-specific simulation of blood flow in the “valve-in-valve” complex formed from a failed framed and transcatheter self-expanding aortic valve bioprosthesis. The three-dimensional computer models of the aortic root, the frame, and the transcatheter bioprosthesis were reconstructed using the multislice computed tomographic data of patient T. aged 61 years who underwent “valve-in-valve” implantation of a self-expanding valve (CoreValve™; Medtronic, Dublin, Ireland). Computer modelling was performed with the immersed boundary method, considering the haemodynamic characteristics of the patient which were obtained by postoperative transthoracic echocardiography. Qualitative and quantitative indicators of blood flow average and peak blood flow velocities, wall shear, viscous stress, and Reynolds stress were analysed, as were the distributions of these indicators in the blood flow volume of the model. Particular attention was paid to these indicators with regard to the area of observation of the first-degree paraprosthetic regurgitation in the zone of mitral–aortic contact; such regurgitation was clinically observed at 6 months.
Results. In numerical simulations, high blood flow velocities in the region of interest (the area of the paraprosthetic blood leakage) as well as stresses (viscous and Reynolds stresses) do not generally cause substantial mechanical destruction of red blood cells because of the short exposure time. In the wall of the fistula, the high shear stress that results from the simulation of high blood flow velocities can initiate thrombosis with the participation of von Willebrand factor in the case of endothelial inflow of the primary bioprosthesis with dysfunction. However, these effects were not clinically observed.
Conclusion. As a result of clinically observed first-degree paraprosthetic regurgitation caused by the low position of the CoreValve™ transcatheter prosthesis in relation to the primary frame bioprosthesis, the contact area of the prosthesis-in-prosthesis was reduced. The patient-specific methods used to assess haemodynamic effects arising from transcatheter prosthetics satisfactorily reproduced the clinical picture of paraprosthetic regurgitation and can form the basis of numerical prognostic models of similar interventions.

Received 12 June 2019. Revised 31 October 2019. Accepted 6 November 2019.

Funding: The research is supported by a grant of the Russian Science Foundation (project No. 18-75-10061).

Conflict of interest: Authors declare no conflict of interest.

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References

  1. Midha P.A., Raghav V, Okafor I., Yoganathan A.P. The effect of valve-in-valve implantation height on sinus flow. Ann Biomed Eng. 2017;45(2):405-12. PMID: 27164838. https://doi.org/10.1007/s10439-016-1642-2
  2. Бокерия Л.А., Милиевская Е.Б., Кудзоева З.Ф., Прянишников В.В. Сердечно-сосудистая хирургия – 2017. Болезни и врожденные аномалии системы кровообращения. М.: НМИЦ ССХ им. А.Н. Бакулева Минздрава России, 2018. 252 с. [Bokeriya L.A., Milievskaya E.B., Kudzoeva Z.F., Pryanishnikov V.V. Cardiovascular Surgery – 2017. Disease and congenital anomalies of circulatory system. Мoscow: A.N. Bakoulev Scientific Center for Cardiovascular Surgery; 2018. 252 p. (In Russ.)]
  3. Paradis J.M., Del Trigo M., Puri R., Rodés-Cabau J. Transcatheter valve-in-valve and valve-in-ring for treating aortic and mitral surgical prosthetic dysfunction. J Am Coll Cardiol. 2015;66(18):2019-37. PMID: 26516006. https://doi.org/10.1016/j.jacc.2015.09.015
  4. Carabello B.A., Paulus W.J. Aortic stenosis. Lancet. 2009;373(9667):956-66. PMID: 19232707. https://doi.org/10.1016/S0140-6736(09)60211-7
  5. Musumeci L., Jacques N., Hego A., Nchimi A., Lancellotti P., Oury C. Prosthetic aortic valves: challenges and solutions. Front Cardiovasc Med. 2018;5:46. PMID: 29868612; PMCID: PMC5961329. https://doi.org/10.3389/fcvm.2018.00046
  6. Li KYC. Bioprosthetic heart valves: upgrading a 50-year old technology. Front Cardiovasc Med. 2019;6:47. PMID: 31032263, PMCID: PMC6470412. https://doi.org/10.3389/fcvm.2019.00047
  7. Applegate P.M., Boyd W.D., Applegate Ii R.L., Liu H. Is it the time to reconsider the choice of valves for cardiac surgery: mechanical or bioprosthetic? J Biomed Res. 2017;31(5):373-6. PMID: 28958994, PMCID: PMC5706429. https://doi.org/10.7555/JBR.31.20170027
  8. Reul R.M., Ramchandani M.K., Reardon M.J. Transcatheter aortic valve-in-valve procedure in patients with bioprosthetic structural valve deterioration. Methodist Debakey Cardiovasc J. 2017;13(3):132-41. PMID: 29743998, PMCID: PMC5935197. https://doi.org/10.14797/mdcj-13-3-132
  9. Рабочая группа по ведению пациентов с клапанной болезнью сердца европейского общества кардиологов (ЕОК, ESC) и европейской ассоциации кардио-торакальной хирургии (EACTS) рекомендации ESC/EACTS 2017 по лечению клапанной болезни сердца (текст доступен в электронной версии). Российский кардиологический журнал. 2018;(7):103-155. https://doi.org/10.15829/1560-4071-2018-7-103-155 [The task force for the management of valvular heart disease of the European society of cardiology (ESC) and the European association for cardio-thoracic surgery (EACTS) 2017 ESC/EACTS guidelines for the management of valvular heart disease (text is available in electronic version). Russian Journal of Cardiology. 2018;(7):103-155. (In Russ.) https://doi.org/10.15829/1560-4071-2018-7-103-155]
  10. Erlebach M., Wottke M., Deutsch M.A., Krane M., Piazza N., Lange R., Bleiziffer S. Redo aortic valve surgery versus transcatheter valve-in-valve implantation for failing surgical bioprosthetic valves: consecutive patients in a single-center setting. J Thorac Dis. 2015;7(9):1494-500. PMID: 26543594, PMCID: PMC4598513. https://doi.org/10.3978/j.issn.2072-1439.2015.09.24
  11. Leontyev S., Borger M.A., Davierwala P., Walther T., Lehmann S., Kempfert J., Mohr F.W. Redo aortic valve surgery: early and late outcomes. Ann Thorac Surg. 2011;91(4):1120-6. PMID: 21276956. https://doi.org/10.1016/j.athoracsur.2010.12.053
  12. Takagi H., Mitta S., Ando T. Meta-analysis of valve-in-valve transcatheter versus redo surgical aortic valve replacement. Thorac Cardiovasc Surg. 2018;67(4):243-250. PMID: 30114716. https://doi.org/10.1055/s-0038-1668135
  13. Leon M.B., Smith C.R., Mack M.J., Makkar R.R., Svensson L.G., Kodali S.K., Thourani V.H., Tuzcu E.M., Miller D.C., Herrmann H.C., Doshi D., Cohen D.J., Pichard A.D., Kapadia S., Dewey T., Babaliaros V., Szeto W.Y., Williams M.R., Kereiakes D., Zajarias A., Greason K.L., Whisenant B.K., Hodson R.W., Moses J.W., Trento A., Brown D.L., Fearon W.F., Pibarot P., Hahn R.T., Jaber W.A., Anderson W.N., Alu M.C., Webb J.G.; PARTNER 2 Investigators. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. New Engl J Med. 2016;374(17):1609-20. PMID: 27040324. https://doi.org/10.1056/NEJMoa1514616
  14. Reardon M.J., Van Mieghem N.M., Popma J.J., Kleiman N.S., Søndergaard L., Mumtaz M., Adams D.H., Deeb G.M., Maini B., Gada H., Chetcuti S., Gleason T., Heiser J., Lange R., Merhi W., Oh J.K., Olsen P.S., Piazza N., Williams M., Windecker S., Yakubov S.J., Grube E., Makkar R., Lee J.S., Conte J., Vang E., Nguyen H., Chang Y., Mugglin A.S., Serruys P.W., Kappetein A.P.; SURTAVI Investigators. Surgical or transcatheter aortic-valve replacement in intermediate-risk patients. New Engl J Med. 2017;376(14):1321-31. PMID: 28304219. https://doi.org/10.1056/NEJMoa1700456
  15. Choi C.H., Cheng V., Malaver D., Kon N., Kincaid E.H., Gandhi S.K., Applegate R.J., Zhao D.X.M. A comparison of valve-in-valve transcatheter aortic valve replacement in failed stentless versus stented surgical bioprosthetic aortic valves. Catheter Cardiovasc Interv. 2019;93(6):1106-15. PMID: 30588736, PMCID: PMC6590419. https://doi.org/10.1002/ccd.28039
  16. Schultz C., Rodriguez-Olivares R., Bosmans J., Lefèvre T., De Santis G., Bruining N., Collas V., Dezutter T., Bosmans B., Rahhab Z., El Faquir N., Watanabe Y., Segers P., Verhegghe B., Chevalier B., van Mieghem N., De Beule M., Mortier P., de Jaegere P. Patient-specific image-based computer simulation for theprediction of valve morphology and calcium displacement after TAVI with the Medtronic CoreValve and the Edwards SAPIEN valve. EuroIntervention. 2016;11(9):1044-52. PMID: 26788707. https://doi.org/10.4244/EIJV11I9A212
  17. MacKnight B., Cormican D.S., Villablanca P.A., Fassl J., Núñez Gil I.J., Ramakrishna H. Percutaneous transcatheter valve-in-valve implantation for prosthetic valve disease-an analysis of evolving data and technology. J Cardiothorac Vasc Anesth. 2017;31(4):1527-34. PMID: 29335196. https://doi.org/10.1053/j.jvca.2017.02.010
  18. Zakerzadeh R., Hsu M.C., Sacks M.S. Computational methods for the aortic heart valve and its replacements. Expert Rev Med Devices. 2017;14(11):849-66. PMID: 28980492, PMCID: PMC6542368. https://doi.org/10.1080/17434440.2017.1389274
  19. Vellguth K., Brüning J., Goubergrits L., Tautz L., Hennemuth A., Kertzscher U., Degener F., Kelm M., Sündermann S., Kuehne T. Development of a modeling pipeline for the prediction of hemodynamic outcome after virtual mitral valve repair using image-based CFD. Int J Comput Assist Radiol Surg. 2018;13(11):1795-805. PMID: 30008058. https://doi.org/10.1007/s11548-018-1821-8
  20. Khalili F., Gamage P.P.T., Sandler R.H., Mansy H.A. Adverse hemodynamic conditions associated with mechanical heart valve leaflet immobility. Bioengineering (Basel). 2018;5(3):74. PMID: 30223603, PMCID: PMC6165326. https://doi.org/10.3390/bioengineering5030074
  21. Yen J.H., Chen S.F., Chern M.K., Lu P.C. The effect of turbulent viscous shear stress on red blood cell hemolysis. J Artif Organs. 2014;17(2):178-85. PMID: 24619800. https://doi.org/10.1007/s10047-014-0755-3
  22. Casa L.D., Deaton D.H., Ku D.N. Role of high shear rate in thrombosis. J Vasc Surg. 2015;61(4):1068-80. PMID: 25704412. https://doi.org/10.1016/j.jvs.2014.12.050
  23. Geers A.J., Morales H.G., Larrabide I., Butakoff C., Bijlenga P., Frangi A.F. Wall shear stress at the initiation site of cerebral aneurysms. Biomech Model Mechanobiol. 2017;16(1):97-115. PMID: 27440126. https://doi.org/10.1007/s10237-016-0804-3
  24. Tuzcu E.M., Kapadia S.R., Vemulapalli S., Carroll J.D., Holmes D.R. Jr., Mack M.J., Thourani V.H., Grover F.L., Brennan J.M., Suri R.M., Dai D., Svensson L.G. Transcatheter aortic valve replacement of failed surgically implanted bioprostheses: the STS/ACC registry. J Am Coll Cardiol. 2018;72(4):370-82. PMID: 30025572. https://doi.org/10.1016/j.jacc.2018.04.074
  25. Wilczek K., Bujak K., Reguła R., Chodór P., Osadnik T. Risk factors for paravalvular leak after transcatheter aortic valve implantation. Kardiochir Torakochirurgia Pol. 2015;12(2):89-94. PMCID: PMC4550021, PMID: 26336489. https://doi.org/10.5114/kitp.2015.52848
  26. Kleczyński P., Dziewierz A., Daniec M., Bagieński M., Rzeszutko Ł., Sorysz D., Trębacz J., Sobczyński R., Tomala M., Dudek D. Impact of post-dilatation on the reduction of paravalvular leak and mortality after transcatheter aortic valve implantation. Kardiol Pol. 2017;75(8):742-8. PMID: 28819953. https://doi.org/10.5603/KP.2017.0152
  27. Butcher J.T., Nerem R.M. Valvular endothelial cells and the mechanoregulation of valvular pathology. Philos Trans R Soc Lond B Biol Sci. 2007;362(1484):1445-57. PMCID: PMC2440407, PMID: 17569641. https://doi.org/10.1098/rstb.2007.2127