Long-term prognostic impact of paravalvular leakage on coronary artery disease requires patient-specific quantification of hemodynamics

被引:8
|
作者
Khodaei, Seyedvahid [1 ]
Garber, Louis [2 ]
Bauer, Julia [1 ]
Emadi, Ali [1 ,3 ]
Keshavarz-Motamed, Zahra [1 ,2 ,4 ]
机构
[1] McMaster Univ, Dept Mech Engn, Hamilton, ON L8S4L7, Canada
[2] McMaster Univ, Sch Biomed Engn, Hamilton, ON, Canada
[3] McMaster Univ, Dept Elect & Comp Engn, Hamilton, ON, Canada
[4] McMaster Univ, Sch Computat Sci & Engn, Hamilton, ON, Canada
基金
加拿大自然科学与工程研究理事会;
关键词
TRANSCATHETER AORTIC-VALVE; WALL SHEAR-STRESS; PRESSURE-VOLUME RELATION; FRACTIONAL FLOW RESERVE; BLOOD-FLOW; IN-VITRO; COMPUTED-TOMOGRAPHY; LEAFLET THROMBOSIS; ASCENDING AORTA; HEART;
D O I
10.1038/s41598-022-21104-8
中图分类号
O [数理科学和化学]; P [天文学、地球科学]; Q [生物科学]; N [自然科学总论];
学科分类号
07 ; 0710 ; 09 ;
摘要
Transcatheter aortic valve replacement (TAVR) is a frequently used minimally invasive intervention for patient with aortic stenosis across a broad risk spectrum. While coronary artery disease (CAD) is present in approximately half of TAVR candidates, correlation of post-TAVR complications such as paravalvular leakage (PVL) or misalignment with CAD are not fully understood. For this purpose, we developed a multiscale computational framework based on a patient-specific lumped-parameter algorithm and a 3-D strongly-coupled fluid-structure interaction model to quantify metrics of global circulatory function, metrics of global cardiac function and local cardiac fluid dynamics in 6 patients. Based on our findings, PVL limits the benefits of TAVR and restricts coronary perfusion due to the lack of sufficient coronary blood flow during diastole phase (e.g., maximum coronary flow rate reduced by 21.73%, 21.43% and 21.43% in the left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) respectively (N = 6)). Moreover, PVL may increase the LV load (e.g., LV load increased by 17.57% (N = 6)) and decrease the coronary wall shear stress (e.g., maximum wall shear stress reduced by 20.62%, 21.92%, 22.28% and 25.66% in the left main coronary artery (LMCA), left anterior descending (LAD), left circumflex (LCX) and right coronary artery (RCA) respectively (N = 6)), which could promote atherosclerosis development through loss of the physiological flow-oriented alignment of endothelial cells. This study demonstrated that a rigorously developed personalized image-based computational framework can provide vital insights into underlying mechanics of TAVR and CAD interactions and assist in treatment planning and patient risk stratification in patients.
引用
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页数:31
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