An Evaluation of the Influence of Coronary Flow on Transcatheter Heart Valve Neo-Sinus Flow Stasis

• Published in: Annals of biomedical engineering Vol. 48; no. 1; pp. 169 - 180
• Main Authors: Madukauwa-David, Immanuel David, Sadri, Vahid, Midha, Prem A, Babaliaros, Vasilis, Aidun, Cyrus, Yoganathan, Ajit P.
• Format: Journal Article
• Language: English
• Published: New York Springer US 01.01.2020; Springer Nature B.V
• Subjects: Biochemistry; Biological and Medical Physics; Biomedical and Life Sciences; Biomedical Engineering and Bioengineering; Biomedicine; Biophysics; Classical Mechanics; Computer simulation; Embolism; Heart; Heart valves; Hemodynamics; Hibernation; Particle image velocimetry; Risk analysis; Risk factors; Sinuses; Thromboembolism; Thrombosis; Velocity distribution; Velocity measurement; Flow Stasis; Particle image velocimetry; Coronary flow; Neo-sinus; Thrombosis; TAVR
• ISSN: 0090-6964; 1573-9686
• DOI: 10.1007/s10439-019-02324-y

Transcatheter heart valve (THV) leaflet thrombosis in the neo-sinus and associated reduced leaflet motion is of clinical concern due to risks of embolism and worsened valve hemodynamics. Flow stasis in the neo-sinus (the space between the native and THV leaflets) is a known risk factor, but the role of proximal coronary flow is yet to be investigated. We tested two replicas of FDA approved commercial THVs—intra-annular and supra-annular (similar to the SAPIEN 3 and CoreValve families)—in a left heart simulator with coronary flow. Velocity fields in the left coronary cusp (LCC) and non (NCC) neo-sinus were quantified using high speed particle image velocimetry and particle residence times (PRT) were computed to evaluate flow stasis in the region. The supra-annular THV LCC neo-sinus had shorter PRT than its NCC neo-sinus (0.66 ± 0.00 vs. 0.76 ± 0.04, p  = 0.038), while the intra-annular THV LCC neo-sinus had similar PRT to its NCC neo-sinus (1.93 ± 0.05 vs. 1.92 ± 0.03 cycles, p  = 0.889). The supra-annular valve LCC and NCC neo-sinuses had shorter PRT than their intra-annular valve counterparts ( p < 0.001). These results showed that coronary flow reduces flow stasis in the supra-annular THV neo-sinus and, ostensibly, thrombosis risk in the region. This effect was not significant in the intra-annular valve.