Leaflet Laceration to Improve Neosinus and Sinus Flow After Valve-in-Valve
2019; Lippincott Williams & Wilkins; Volume: 12; Issue: 3 Linguagem: Inglês
10.1161/circinterventions.118.007739
ISSN1941-7632
AutoresHoda Hatoum, Pablo Maureira, Scott Lilly, Lakshmi Prasad Dasi,
Tópico(s)Infective Endocarditis Diagnosis and Management
ResumoHomeCirculation: Cardiovascular InterventionsVol. 12, No. 3Leaflet Laceration to Improve Neosinus and Sinus Flow After Valve-in-Valve Free AccessLetterPDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessLetterPDF/EPUBLeaflet Laceration to Improve Neosinus and Sinus Flow After Valve-in-Valve Hoda Hatoum, PhD, Pablo Maureira, MD, PhD, Scott Lilly, MD, PhD and Lakshmi Prasad Dasi, PhD Hoda HatoumHoda Hatoum Department of Biomedical Engineering, The Ohio State University, Columbus (H.H., L.P.D.). , Pablo MaureiraPablo Maureira Department of Cardiovascular Surgery, CHU de Nancy, France (P.M.). , Scott LillyScott Lilly Division of Cardiovascular Medicine, Department of Internal Medicine, The Ohio State University, Columbus (S.L.). and Lakshmi Prasad DasiLakshmi Prasad Dasi Lakshmi Prasad Dasi, PhD, Associate Professor, Department of Biomedical Engineering, The Ohio State University, 473 W 12th Ave, Columbus, OH 43210. Email E-mail Address: [email protected] Department of Biomedical Engineering, The Ohio State University, Columbus (H.H., L.P.D.). Originally published7 Mar 2019https://doi.org/10.1161/CIRCINTERVENTIONS.118.007739Circulation: Cardiovascular Interventions. 2019;12:e007739Subclinical leaflet thrombosis after transcatheter aortic valve replacement in native and existing bioprosthetic valves (valve-in-valve) has been associated with a greater incidence of valve degeneration and cerebroembolic events.1 Native and neosinus flow stasis has been implicated in this phenomenon,2,3 and if this were avoided, it is possible that the risk of developing leaflet thrombus could be avoided. This concern is particularly relevant in valve-in-valve cases, where a higher incidence of subclinical leaflet thrombosis is observed.4 Recently, several studies have introduced the bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction also known as BASILICA.5 Despite being used in the context of mitigating coronary obstruction, BASILICA introduces a laceration to the leaflet that opens a narrow but direct flow pathway between the sinus and the neosinus, and thus potentially altering flow dynamics in both sinus and neosinus. The objective of this study is to quantify neosinus and sinus flow washout with and without leaflet laceration in the context of assessing the potential of laceration as a strategy to reduce the incidence of leaflet thrombosis.This study adheres to the American Heart Association Journals' implementation of the Transparency and Openness Promotion Guidelines. The data used to generate the findings of this study are available from the corresponding author on reasonable request. A 23 mm Edwards SAPIEN 3 was implanted in a 23 mm transparent surgical aortic valve model without and with leaflet laceration (Figure [A and B]). The hemodynamic assessment of the transcatheter aortic valve (5 L/min cardiac output, 60 beats per minute heart rate and 120/80 mm Hg pressures) was performed in a pulse duplicator left heart simulator flow loop described previously.3 To evaluate the flow field and washout in the sinus and the neosinus, particle image velocimetry was performed. Using Lagrangian particle tracking method as previously described3 over 18 different cardiac cycles, the number of cycles to washout was calculated. Student t test was performed to assess the statistical significance of the difference in number of cycles to washout pre and post leaflet laceration after confirming normality using the Shapiro-Wilks test with a P value of 0.756.Download figureDownload PowerPointFigure. In-vitro model to quantify neosinus and sinus flow dynamics and washout as a function of leaflet laceration with quantitative sinus flow patterns and time washout characteristics with and without leaflet laceration.A and B, Valve-in-valve setup with SAPIEN 3 transcatheter aortic valve without and with leaflet laceration; (C and D) particle image velocimetry vector field images showing the flow across the leaflet between the neosinus and the sinus during leaflet opening; and (E) washout results in the neosinus and the sinus with and without leaflet laceration.The results revealed that introducing a laceration to the leaflet allows flow to cross laterally from the neosinus to the sinus compared with cases where no-lacerations were modeled (Figure [C and D]). This resulted in an enhancement of washout in the neosinus and in pushing the existing sinus blood volume into exiting distally in parallel with aortic blood flow. The velocity at the proximity of the leaflet between the neosinus and the sinus regions at peak systole without laceration was 0.017±0.002 m/s, whereas after laceration was 0.029±0.006 m/s. Quantitatively, as shown in the Figure (E), after lacerating the leaflet, the number of cycles to washout in the neosinus decreased from 3.07±0.08 cycles to 0.70±0.11 cycles (P<0.0001). Similarly, relatively marginal improvement in washout was also found in the sinus after leaflet laceration, requiring only 1.87±0.13 cycles compared with that without laceration 2.11±0.08 cycles (P<0.01).Many factors are implicated in the likelihood of leaflet thrombosis, and the incidence of leaflet thrombus formation after valve-in-valve with balloon-expandable transcatheter aortic valves is more common compared with other procedures, and other valve types.4 Lacerating the leaflet may actually provide a promising solution to avoid this complication or as an additional intervention to prevent reoccurrence of leaflet thrombosis.In summary, this study examined the potential benefits that leaflet laceration may offer in the context of improving neosinus and sinus flow, mitigating relative hemostasis in these areas, and likely decreasing the possibility of thrombus formation. These experiments showed that introducing a laceration that allows direct flow between the neosinus and the sinus improves sinus washout making it a potentially promising technique to prevent leaflet thrombus. Although this study simulated valve-in-valve conditions, it is foreseeable that the same mechanisms would apply to transcatheter aortic valve replacement in native aortic valves, where reduced sinus flow has also been implicated in subclinical leaflet thrombosis and adverse clinical outcomes.DisclosuresL.P. Dasi reports having patent applications filed on novel polymeric valves, vortex generators and superhydrophobic/omniphobic surfaces. The other authors report no conflicts.Sources of FundingThe research was partly supported by the NIH under Award Number R01HL119824.FootnotesLakshmi Prasad Dasi, PhD, Associate Professor, Department of Biomedical Engineering, The Ohio State University, 473 W 12th Ave, Columbus, OH 43210. Email lakshmi.[email protected]eduReferences1. Makki N, Shreenivas S, Kereiakes D, Lilly S. A meta-analysis of reduced leaflet motion for surgical and transcatheter aortic valves: relationship to cerebrovascular events and valve degeneration.Cardiovasc Revasc Med. 2018; 19(7pt B):868–873. doi: 10.1016/j.carrev.2018.03.003CrossrefMedlineGoogle Scholar2. Midha PA, Raghav V, Sharma R, Condado JF, Okafor IU, Rami T, Kumar G, Thourani VH, Jilaihawi H, Babaliaros V, Makkar RR, Yoganathan AP. The fluid mechanics of transcatheter heart valve leaflet thrombosis in the neosinus.Circulation. 2017; 136:1598–1609. doi: 10.1161/CIRCULATIONAHA.117.029479LinkGoogle Scholar3. Hatoum H, Dollery J, Lilly SM, Crestanello JA, Dasi LP. Implantation depth and rotational orientation effect on valve-in-valve hemodynamics and sinus flow.Ann Thorac Surg. 2018; 106:70–78. doi: 10.1016/j.athoracsur.2018.01.070CrossrefMedlineGoogle Scholar4. Jose J, Sulimov DS, El-Mawardy M, Sato T, Allali A, Holy EW, Becker B, Landt M, Kebernik J, Schwarz B, Richardt G, Abdel-Wahab M. Clinical bioprosthetic heart valve thrombosis after transcatheter aortic valve replacement: incidence, characteristics, and treatment outcomes.JACC Cardiovasc Interv. 2017; 10:686–697. doi: 10.1016/j.jcin.2017.01.045CrossrefMedlineGoogle Scholar5. Dvir D, Khan J, Kornowski R, Komatsu I, Chatriwalla A, Mackenson GB, Simonato M, Ribeiro H, Wood D, Leipsic J, Webb J, Mylotte D. Novel strategies in aortic valve-in-valve therapy including bioprosthetic valve fracture and BASILICA.EuroIntervention. 2018; 14(AB):AB74–AB82. doi: 10.4244/EIJ-D-18-00667CrossrefMedlineGoogle Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Hatoum H, Samaee M, Sathananthan J, Sellers S, Kuetting M, Lilly S, Ihdayhid A, Blanke P, Leipsic J, Thourani V and Dasi L (2022) Comparison of performance of self-expanding and balloon-expandable transcatheter aortic valves, JTCVS Open, 10.1016/j.xjon.2022.04.015, 10, (128-139), Online publication date: 1-Jun-2022. Vogl B, Niemi N, Griffiths L, Alkhouli M and Hatoum H (2021) Impact of calcific aortic valve disease on valve mechanics, Biomechanics and Modeling in Mechanobiology, 10.1007/s10237-021-01527-4, 21:1, (55-77), Online publication date: 1-Feb-2022. Hatoum H, Gooden S, Sathananthan J, Sellers S, Kutting M, Marx P, Lilly S, Ihdayhid A, Thourani V and Dasi L (2021) Neosinus and Sinus Flow After Self-Expanding and Balloon-Expandable Transcatheter Aortic Valve Replacement, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2021.09.013, 14:24, (2657-2666), Online publication date: 1-Dec-2021. Plitman Mayo R, Yaakobovich H, Finkelstein A, Shadden S and Marom G (2021) Impact of BASILICA on the thrombogenicity potential of valve-in-valve implantations, Journal of Biomechanics, 10.1016/j.jbiomech.2021.110309, 118, (110309), Online publication date: 1-Mar-2021. Yaakobovich H, Plitman Mayo R, Zaretsky U, Finkelstein A, Weiss D and Marom G (2021) The effect of clinically recommended Evolut sizes on anchorage forces after BASILICA, Journal of Biomechanics, 10.1016/j.jbiomech.2021.110303, 118, (110303), Online publication date: 1-Mar-2021. Komatsu I, Wijeysandera H, Radharkrisnan S, Whisenant B, Simonato M, Chen A, Mackensen G, Reisman M, Spies C, Goel K, Abdel-Wahab M and Dvir D (2020) Technical Considerations and Pitfalls of BASILICA: Bioprosthetic or Native Aortic Scallop Intentional Laceration to Prevent Iatrogenic Coronary Artery Obstruction, Structural Heart, 10.1080/24748706.2020.1742406, 4:3, (169-178), Online publication date: 1-May-2020. Yaakobovich H, Plitman Mayo R, Zaretsky U, Finkelstein A and Marom G (2019) Numerical models of valve-in-valve implantation: effect of intentional leaflet laceration on the anchorage, Biomechanics and Modeling in Mechanobiology, 10.1007/s10237-019-01218-1, 19:2, (415-426), Online publication date: 1-Apr-2020. Hatoum H, Maureira P, Lilly S and Dasi L (2020) Impact of BASILICA on Sinus and Neo-Sinus Hemodynamics after Valve-in-Valve with and without Coronary Flow, Cardiovascular Revascularization Medicine, 10.1016/j.carrev.2019.06.015, 21:3, (271-276), Online publication date: 1-Mar-2020. Khan J, Rogers T, Waksman R, Torguson R, Weissman G, Medvedofsky D, Craig P, Zhang C, Gordon P, Ehsan A, Wilson S, Goncalves J, Levitt R, Hahn C, Parikh P, Bilfinger T, Butzel D, Buchanan S, Hanna N, Garrett R, Shults C, Garcia-Garcia H, Kolm P, Satler L, Buchbinder M, Ben-Dor I and Asch F (2019) Hemodynamics and Subclinical Leaflet Thrombosis in Low-Risk Patients Undergoing Transcatheter Aortic Valve Replacement, Circulation: Cardiovascular Imaging, 12:12, Online publication date: 1-Dec-2019. Lederman R, Babaliaros V, Rogers T, Khan J, Kamioka N, Dvir D and Greenbaum A (2019) Preventing Coronary Obstruction During Transcatheter Aortic Valve Replacement, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2019.04.052, 12:13, (1197-1216), Online publication date: 1-Jul-2019. Hatoum H, Maureira P, Lilly S and Dasi L (2019) Impact of Leaflet Laceration on Transcatheter Aortic Valve-in-Valve Washout, JACC: Cardiovascular Interventions, 10.1016/j.jcin.2019.04.013, 12:13, (1229-1237), Online publication date: 1-Jul-2019. March 2019Vol 12, Issue 3 Advertisement Article InformationMetrics © 2019 American Heart Association, Inc.https://doi.org/10.1161/CIRCINTERVENTIONS.118.007739PMID: 30841710 Originally publishedMarch 7, 2019 Keywordssystolethrombosislacerationcardiac outputhemodynamicPDF download Advertisement SubjectsHemodynamicsTranslational Studies
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