Skip to main content
SpringerLink
Log in

Differences in Pressure Recovery Between Balloon Expandable and Self-expandable Transcatheter Aortic Valves

  • Original Article
  • Published:
Annals of Biomedical Engineering Aims and scope Submit manuscript

Abstract

Pressure recovery downstream of the aortic valve constitutes an important factor affecting the calculation of pressure gradient (PG) across the valve and therefore the accuracy of the calculated aortic valve area. Some clinical studies hypothesized that stent and valve cusps design contribute to flow acceleration and Doppler-measured valve gradients across the balloon-expandable transcatheter aortic valve. This study aims at elucidating the physical mechanisms behind pressure recovery variations between Edwards SAPIEN 3 and Medtronic Evolut TAVs through the measurements of sensitive and precise axial pressure profiles. A 23 mm Edwards SAPIEN3 and a 26 mm Medtronic Evolut were deployed in a pulse duplicator. A Millar catheter was used to record 50 cycles of pressure data along the centerline of the valve chamber upstream and downstream of the valve. The peak PG obtained with SAPIEN at vena contracta (VC) is 18.83 ± 0.75 mmHg and after recovery, 9.56 ± 0.78 mmHg. For Evolut at VC, peak PG is 18.25 ± 0.63 mmHg and after recovery, 10.3 ± 0.57 mmHg. The differences in peak PG at VC and at the recovery were statistically significant (p < 0.001). With SAPIEN 3 at VC, the mean PG obtained is 10.11 ± 0.63 mmHg and after recovery 7.06 ± 0.46 mmHg. For Evolut, mean PG at VC is 10.45 ± 0.67 mmHg and after recovery 7.99 ± 0.61 mmHg. The differences between the mean PG between the two valves was not statistically significant at VC (p = 0.71) but significant post-recovery (p < 0.00001). While gradients at the VC are higher with the SAPIEN 3, the net gradient after pressure recovery is significantly lower compared to Evolut TAV. Efficiency of pressure recovery significantly depends on valve type due to stent interference with the recovering blood flow.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Figure 1
Figure 2
Figure 3
Figure 4
Figure 5
Figure 6
Figure 7

Similar content being viewed by others

Abbreviations

PG:

Pressure gradient

TAVR:

Transcatheter aortic valve replacement

VC:

Vena contracta

References

  1. Alston, M., et al. 600.19 Invasive versus Doppler-derived gradients after TAVR. JACC Cardiovasc Interv 12(4):S48, 2019.

    Article  Google Scholar 

  2. Bach, D. S. Echo/Doppler evaluation of hemodynamics after aortic valve replacement: principles of interrogation and evaluation of high gradients. JACC Cardiovasc Imaging 3(3):296–304, 2010.

    Article  Google Scholar 

  3. Bahlmann, E., et al. Impact of pressure recovery on echocardiographic assessment of asymptomatic aortic stenosis: a SEAS substudy. JACC Cardiovasc Imaging 3(6):555–562, 2010.

    Article  Google Scholar 

  4. Bahlmann, E., et al. Prognostic value of energy loss index in asymptomatic aortic stenosis. Circulation 127(10):1149–1156, 2013.

    Article  Google Scholar 

  5. Baumgartner, H., V. Falk, J. J. Bax, M. De Bonis, et al. ESC/EACTS Guidelines for the management of valvular heart disease: 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). Eur Heart J 2017(38):2739–2791, 2017.

    Article  Google Scholar 

  6. Chambers, J. Is pressure recovery an important cause of “Doppler aortic stenosis” with no gradient at cardiac catheterisation? Heart 76(5):381, 1996.

    Article  CAS  Google Scholar 

  7. Garcia, D., et al. Discrepancies between catheter and Doppler estimates of valve effective orifice area can be predicted from the pressure recovery phenomenon: practical implications with regard to quantification of aortic stenosis severity. J Am Coll Cardiol 41(3):435–442, 2003.

    Article  Google Scholar 

  8. Giersiepen, M., et al. Estimation of shear stress-related blood damage in heart valve prostheses-in vitro comparison of 25 aortic valves. Int J Artif Organs 13(5):300–306, 1990.

    Article  CAS  Google Scholar 

  9. Hahn, R. T., et al. Comprehensive echocardiographic assessment of normal transcatheter valve function. JACC Cardiovasc Imaging 12(1):25–34, 2019.

    Article  Google Scholar 

  10. Hatoum, H., and L. P. Dasi. Spatiotemporal complexity of the aortic sinus vortex as a function of leaflet calcification. Ann Biomed Eng 47(4):1116–1128, 2019.

    Article  Google Scholar 

  11. Hatoum, H., F. Heim, and L. P. Dasi. Stented valve dynamic behavior induced by polyester fiber leaflet material in transcatheter aortic valve devices. J Mech Behav Biomed Mater 86:232–239, 2018.

    Article  CAS  Google Scholar 

  12. Hatoum, H., B. L. Moore, and L. P. Dasi. On the significance of systolic flow waveform on aortic valve energy loss. Ann Biomed Eng 46(12):2102–2111, 2018.

    Article  Google Scholar 

  13. Hatoum, H., et al. Modeling of the instantaneous transvalvular pressure gradient in aortic stenosis. Ann Biomed Eng 48:1748–1763, 2019.

    Article  Google Scholar 

  14. Lancellotti, P., et al. Recommendations for the imaging assessment of prosthetic heart valves: a report from the European Association of Cardiovascular Imaging endorsed by the Chinese Society of Echocardiography, the Inter-American Society of Echocardiography, and the Brazilian Department of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 17(6):589–590, 2016.

    Article  Google Scholar 

  15. Mando, R., et al. Echo overestimates trans-aortic gradients immediately post TAVR: a pressure recovery phenomenon in a simultaneous CATH and ECHO study. J Am Coll Cardiol 73(9):1251, 2019.

    Article  Google Scholar 

  16. Nygaard, H., et al. Two-dimensional color-mapping of turbulent shear stress distribution downstream of two aortic bioprosthetic valves in vitro. J Biomech 25(4):429–440, 1992.

    Article  CAS  Google Scholar 

  17. Otto, C. M. Valvular aortic stenosis: disease severity and timing of intervention. J Am Coll Cardiol 47(11):2141–2151, 2006.

    Article  Google Scholar 

  18. Schoephoerster, R. T., and K. B. Chandran. Velocity and turbulence measurements past mitrial valve prostheses in a model left ventricle. J Biomech 24(7):549–562, 1991.

    Article  CAS  Google Scholar 

  19. Yang, S.K. and M.K. Chung. Turbulent flow through mixing spacer grids in rod bundles. In: 1995 National Heat Transfer Conference: Proceedings, Volume 14: Thermal Hydraulics of Advanced Nuclear Reactors, Containment Thermal-Hydraulics, HTD Volume 316, 1995.

  20. Yudi, M. B., et al. Coronary angiography and percutaneous coronary intervention after transcatheter aortic valve replacement. J Am Coll Cardiol 71(12):1360–1378, 2018.

    Article  Google Scholar 

  21. Zoghbi, W. A., et al. Guidelines for the evaluation of valvular regurgitation after percutaneous valve repair or replacement: a report from the American Society of Echocardiography developed in collaboration with the Society for Cardiovascular Angiography And Interventions, Japanese Society of Echocardiography, and Society for Cardiovascular Magnetic Resonance. J Am Soc Echocardiogr 32(4):431–475, 2019.

    Article  Google Scholar 

Download references

Disclosures

Dr. Dasi reports having patent applications filed on novel polymeric valves, vortex generators and superhydrophobic/omniphobic surfaces. Dr. Hahn is a consultant for Edwards Lifescience and Medtronic, and is Chief Scientific Officer for the Echocardiography Core Laboratory at the Cardiovascular Research Foundation for multiple industry-sponsored trials, for which she receives no direct industry compensation. No other conflicts were reported.

Funding

The research done was partly supported by National Institutes of Health (NIH) under Award Number R01HL119824 and the American Heart Association (AHA) under Award Number 19POST34380804.

Author information

Authors and Affiliations

  1. Department of Biomedical Engineering, The Ohio State University, 473 W 12th Ave, Columbus, OH, 43210, USA

    Hoda Hatoum & Lakshmi Prasad Dasi

  2. Division of Cardiology, Columbia University Medical Center, New York, NY, USA

    Rebecca T. Hahn

  3. Division of Cardiovascular Medicine, The Ohio State University, Columbus, OH, USA

    Scott Lilly

Authors
  1. Hoda Hatoum
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Rebecca T. Hahn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Scott Lilly
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Lakshmi Prasad Dasi
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Lakshmi Prasad Dasi.

Additional information

Associate Editor Joel Stitzel oversaw the review of this article.

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Video 1 Pressure gradient at peak flow variations during the cardiac cycle with SAPIEN 3 and Evolut at peak flow time point (AVI 6216 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hatoum, H., Hahn, R.T., Lilly, S. et al. Differences in Pressure Recovery Between Balloon Expandable and Self-expandable Transcatheter Aortic Valves. Ann Biomed Eng 48, 860–867 (2020). https://doi.org/10.1007/s10439-019-02425-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10439-019-02425-8

Keywords

Search

Navigation