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Transcatheter Valve Underexpansion Limits Leaflet Durability: Implications for Valve-in-Valve Procedures

  • The Pursuit of Engineering the Ideal Heart Valve Replacement or Repair
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Abstract

Transcatheter aortic valve (TAV) implantation within a failed bioprosthetic valve is a growing trend for high-risk patients. The non-compliant stent of the previous prosthesis may prevent full expansion of the TAV, which has been shown to distort the leaflet configuration, and has been hypothesized to adversely affect durability. In this study, TAV leaflet fatigue damage under cyclic pressurization in the setting of stent underexpansion by 0 (fully expanded), 1, 2 and 3 mm was simulated using finite element analysis to test this hypothesis. In the 2 and 3 mm underexpanded devices, the TAV leaflets exhibited severe pin-wheeling during valve closure, which increased leaflet stresses dramatically, and resulted in accelerated fatigue damage of the leaflets. The leaflet fatigue damage in the 1 mm underexpanded case was similar to that in the fully expanded case. Clinically a range of 10–15% underexpansion is generally considered acceptable; however, it was observed in this study that ≥2 mm (≥9.1%) underexpansion, will significantly impact device durability. Further study is necessary to determine the impact of various deployment conditions, i.e. non-uniform and non-circular deployments and different implantation heights, on differing TAV devices, but it is clear that the normal TAV leaflet configuration must be preserved in order to preserve durability.

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Acknowledgments

Research for this project was funded in part by NIH HL104080 and HL108240 grants and a NIH F31 HL112632 predoctoral fellowship.

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  1. Tissue Mechanics Laboratory, The Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Technology Enterprise Park, Room 206, 387 Technology Circle, Atlanta, GA, 30313-2412, USA

    Caitlin Martin & Wei Sun

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Correspondence to Wei Sun.

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Associate Editor Jane Grande-Allen oversaw the review of this article.

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Martin, C., Sun, W. Transcatheter Valve Underexpansion Limits Leaflet Durability: Implications for Valve-in-Valve Procedures. Ann Biomed Eng 45, 394–404 (2017). https://doi.org/10.1007/s10439-016-1738-8

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  • DOI: https://doi.org/10.1007/s10439-016-1738-8

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