Skip to main content
SpringerLink
Log in

Simulations of transcatheter aortic valve implantation: implications for aortic root rupture

  • Original Paper
  • Published:
Biomechanics and Modeling in Mechanobiology Aims and scope Submit manuscript

Abstract

Aortic root rupture is one of the most severe complications of transcatheter aortic valve implantation (TAVI). The mechanism of this adverse event remains mostly unknown. The purpose of this study was to obtain a better understanding of the biomechanical interaction between the tissue and stent for patients with a high risk of aortic rupture. We simulated the stent deployment process of three TAVI patients with high aortic rupture risk using finite element method. The first case was a retrospective analysis of an aortic rupture case, while the other two cases were prospective studies, which ended with one canceled procedure and one successful TAVI. Simulation results were evaluated for the risk of aortic root rupture, as well as coronary artery occlusion, and paravalvular leak. For Case 1, the simulated aortic rupture location was the same as clinical observations. From the simulation results, it can be seen that the large calcified spot on the interior of the left coronary sinus between coronary ostium and the aortic annulus was pushed by the stent, causing the aortic rupture. For Case 2 and Case 3, predicated results from the simulations were presented to the clinicians at multidisciplinary pre-procedure meetings; and they were in agreement with clinician’s observations and decisions. Our results indicated that the engineering analysis could provide additional information to help clinicians evaluate complicated, high-risk aortic rupture cases. Since a systematic study of a large patient cohort of aortic rupture is currently not available (due to the low occurrence rate) to clearly understand underlying rupture mechanisms, case-by-case engineering analysis is recommended for evaluating patient-specific aortic rupture risk.

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.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5
Fig. 6
Fig. 7

Similar content being viewed by others

References

  • Auricchio F, Conti M, Morganti S, Reali A (2013) Simulation of transcatheter aortic valve implantation: a patient-specific finite element approach. Comput Methods Biomech Biomed Eng. doi:10.1080/10255842.2012.746676

  • Barbanti M, Yang TH, Tamburino C, Wood DA, Jilaihawi H, Blanke P, Makkar RR, Latib A, Colombo A, Tarantini G, Raju R, Binder RK, Nguyen G, Freeman M, Ribeiro HB, Kapadia S, Min J, Feuchtner G, Gurtvich R, Alqoofi F, Pelletier M, Ussia GP, Napodano M, de Brito FS, Kodali S Jr, Norgaard BL, Hansson NC, Pache G, Canovas SJ, Zhang H, Leon MB, Webb JG, Leipsic J (2013) Anatomical and procedural features associated with aortic root rupture during balloon-expandable transcatheter aortic valve replacement. Circulation 128(3):244–253. doi:10.1161/CIRCULATIONAHA.113.002947

    Article  Google Scholar 

  • Berdajs D (2013) Aortic root rupture: implications of catheter-guided aortic valve replacement. Curr opin cardiol 28(6):632–638. doi:10.1097/HCO.0b013e3283655bb5

    Article  Google Scholar 

  • Capelli C, Bosi GM, Cerri E, Nordmeyer J, Odenwald T, Bonhoeffer P, Migliavacca F, Taylor AM, Schievano S (2012) Patient-specific simulations of transcatheter aortic valve stent implantation. Med Biol Eng Comput 50(2):183–192

    Article  Google Scholar 

  • Capelli C, Nordmeyer J, Schievano S, Lurz P, Khambadkone S, Lattanzio S, Taylor AM, Petrini L, Migliavacca F, Bonhoeffer P (2010) How do angioplasty balloons work: a computational study on balloon expansion forces. Eurointervention 6(5):638–642

    Article  Google Scholar 

  • Cribier A (2012) Development of transcatheter aortic valve implantation (TAVI): A 20-year odyssey. Arch Cardiovasc Dis 105(3):146–152.doi:10.1016/j.acvd.2012.01.005

    Google Scholar 

  • Cribier A, Eltchaninoff H, Bash A, Borenstein N, Tron C, Bauer F, Derumeaux G, Anselme F, Laborde F, Leon MB (2002) Percutaneous transcatheter implantation of an aortic valve prosthesis for calcific aortic stenosis: first human case description. Circulation 106(24):3006–3008

    Article  Google Scholar 

  • De Beule M, Mortier P, Carlier SG, Verhegghe B, Van Impe R, Verdonck P (2008) Realistic finite element-based stent design: the impact of balloon folding. J Biomech 41(2):383–389

    Article  Google Scholar 

  • Ebenstein DM, Coughlin D, Chapman J, Li C, Pruitt LA (2009) Nanomechanical properties of calcification, fibrous tissue, and hematoma from atherosclerotic plaques. J Biomed Mater Res A 91(4):1028–1037

    Article  Google Scholar 

  • Eker A, Sozzi FB, Civaia F, Bourlon F (2012) Aortic annulus rupture during transcatheter aortic valve implantation: safe aortic root replacement. Eur J Cardiothorac Surg 41(5):1205. doi:10.1093/ejcts/ezr146

    Google Scholar 

  • Gasser TC, Ogden RW, Holzapfel GA (2006) Hyperelastic modelling of arterial layers with distributed collagen fibre orientations. J R Soc Interface 3(6):15–35

    Article  Google Scholar 

  • Gervaso F, Capelli C, Petrini L, Lattanzio S, Di Virgilio L, Migliavacca F (2008) On the effects of different strategies in modelling balloon-expandable stenting by means of finite element method. J Biomech 41(6):1206–1212. doi:10.1016/j.jbiomech.2008.01.027

    Article  Google Scholar 

  • Gessat M, Hopf R, Pollok T, Russ C, Frauenfelder T, Sundermann SH, Hirsch S, Mazza E, Szekely G, Falk V (2014) Image-based mechanical analysis of stent deformation: concept and exemplary implementation for aortic valve stents. IEEE Trans Biomed Eng 61(1):4–15. doi:10.1109/TBME.2013.2273496

    Article  Google Scholar 

  • Hayashida K, Bouvier E, Lefevre T, Hovasse T, Morice MC, Chevalier B, Romano M, Garot P, Farge A, Donzeau-Gouge P, Cormier B (2012) Potential mechanism of annulus rupture during transcatheter aortic valve implantation. Catheter Cardiovasc Interv. doi:10.1002/ccd.24524

  • Holzapfel GA, Sommer G, Regitnig P (2004) Anisotropic mechanical properties of tissue components in human atherosclerotic plaques. J Biomech Eng 126(5):657–665

    Article  Google Scholar 

  • Jeziorska M, McCollum C, Wooley DE (1998) Observations on bone formation and remodelling in advanced atherosclerotic lesions of human carotid arteries. Virchows Arch 433(6):559–565

    Article  Google Scholar 

  • Lange R, Bleiziffer S, Mazzitelli D, Elhmidi Y, Opitz A, Krane M, Deutsch MA, Ruge H, Brockmann G, Voss B, Schreiber C, Tassani P, Piazza N (2011a) Improvements in transcatheter aortic valve implantation outcomes in lower surgical risk patients: a glimpse into the future. J Am Coll Cardiol 59(3):280–287

    Article  Google Scholar 

  • Lange R, Bleiziffer S, Piazza N, Mazzitelli D, Hutter A, Tassani-Prell P, Laborde JC, Bauernschmitt R (2011b) Incidence and treatment of procedural cardiovascular complications associated with trans-arterial and trans-apical interventional aortic valve implantation in 412 consecutive patients. Eur J Cardiothorac Surg 40(5):1105–1113

    Google Scholar 

  • Lee L, Henderson R, Baig K (2012) Successful treatment of aortic root rupture following transcatheter aortic valve implantation in a heavily calcified aorta: A novel approach to a serious complication. Catheter Cardiovasc Interv. doi:10.1002/ccd.24468

  • Leon MB, Smith CR, Mack M, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Brown DL, Block PC, Guyton RA, Pichard AD, Bavaria JE, Herrmann HC, Douglas PS, Petersen JL, Akin JJ, Anderson WN, Wang D, Pocock S, Investigators PT (2010) Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N Engl J Med 363(17):1597–1607

    Article  Google Scholar 

  • Lim D, Cho SK, Park WP, Kristensson A, Ko JY, Al-Hassani ST, Kim HS (2008) Suggestion of potential stent design parameters to reduce restenosis risk driven by foreshortening or dogboning due to non-uniform balloon-stent expansion. Ann Biomed Eng 36(7):1118–1129

    Article  Google Scholar 

  • Martin C, Pham T, Sun W (2011) Significant differences in the material properties between aged human and porcine aortic tissues. Eur J Cardiothorac Surg 40(1):28–34

    Article  Google Scholar 

  • Martin C, Sun W (2012) Biomechanical characterization of aortic valve tissue in humans and common animal models. J Biomed Mater Res A 100(6):1591–1599. doi:10.1002/jbm.a.34099

    Article  Google Scholar 

  • Messika-Zeitoun D, Serfaty JM, Brochet E, Ducrocq G, Lepage L, Detaint D, Hyafil F, Himbert D, Pasi N, Laissy JP, Iung B, Vahanian A (2010) Multimodal assessment of the aortic annulus diameter: implications for transcatheter aortic valve implantation. J Am Coll Cardiol 55(3):186–194. doi:10.1016/j.jacc.2009.06.063

    Article  Google Scholar 

  • Mummert J, Sirois E, Sun W (2013) Quantification of biomechanical interaction of transcatheter aortic valve stent deployed in porcine and ovine hearts. Ann Biomed Eng 41(3):577–586. doi:10.1007/s10439-012-0694-1

    Google Scholar 

  • Ogden RW (1972) Large deformation isotropic elasticity—on the correlation of theory and experiment for incompressible rubberlike solids. Proc R Soc Lond A 326(1567):565–584. doi:10.1098/rspa.1972.0026

    Article  MATH  Google Scholar 

  • Pant S, Bressloff NW, Limbert G (2012) Geometry parameterization and multidisciplinary constrained optimization of coronary stents. Biomech Model Mechanobiol 11(1–2):61–82. doi:10.1007/s10237-011-0293-3

  • Pasic M, Unbehaun A, Dreysse S, Buz S, Drews T, Kukucka M, D’Ancona G, Seifert B, Hetzer R (2012) Rupture of the device landing zone during transcatheter aortic valve implantation: a life-threatening but treatable complication. Circ Cardiovasc Interv 5(3):424–432. doi:10.1161/CIRCINTERVENTIONS.111.967315

    Google Scholar 

  • Rezq A, Basavarajaiah S, Latib A, Takagi K, Hasegawa T, Figini F, Cioni M, Franco A, Montorfano M, Chieffo A, Maisano F, Corvaja N, Alfieri O, Colombo A (2012) Incidence, management, and outcomes of cardiac tamponade during transcatheter aortic valve implantation: a single-center study. JACC Cardiovasc Interv 5(12):1264–1272. doi:10.1016/j.jcin.2012.08.012

    Google Scholar 

  • Russ C, Hopf R, Hirsch S, Sundermann S, Falk V, Szekely G, Gessat M Simulation of transcatheter aortic valve implantation under consideration of leaflet calcification. In: Engineering in Medicine and Biology Society (EMBC), 2013 35th Annual International Conference of the IEEE, 3–7 July 2013 2013. pp 711–714. doi:10.1109/EMBC.2013.6609599.

  • Samim M, Stella PR, Agostoni P, Kluin J, Ramjankhan F, Sieswerda G, Budde R, van der Linden M, Juthier F, Banfi C, Hurt C, Hillaert M, van Herwerden L, Bertrand ME, Doevendans PA, Van Belle E (2012) A prospective “oversizing” strategy of the Edwards SAPIEN bioprosthesis: Results and impact on aortic regurgitation. J Thorac Cardiovasc Surg. doi:10.1016/j.jtcvs.2011.12.067

  • Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, Tuzcu EM, Webb JG, Fontana GP, Makkar RR, Williams M, Dewey T, Kapadia S, Babaliaros V, Thourani VH, Corso P, Pichard AD, Bavaria JE, Herrmann HC, Akin JJ, Anderson WN, Wang D, Pocock SJ (2011) Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 364(23):2187–2198. doi:10.1056/NEJMoa1103510

    Article  Google Scholar 

  • Tzamtzis S, Viquerat J, Yap J, Mullen MJ, Burriesci G (2013) Numerical analysis of the radial force produced by the Medtronic–CoreValve and Edwards-SAPIEN after transcatheter aortic valve implantation (TAVI). Med Eng Phys 35(1):125–130. doi:10.1016/j.medengphy.2012.04.009

    Article  Google Scholar 

  • Vad S, Eskinazi A, Corbett T, McGloughlin T, Vande Geest JP (2010) Determination of coefficient of friction for self-expanding stent-grafts. J Biomech Eng 132(12):121007

    Article  Google Scholar 

  • Wang Q, Book G, Primiano C, McKay R, Kodali S, Sun W (2011) Dimensional analysis of aortic root eometry during diastole using 3D models reconstructed from clinical 64-slice computed tomography images. Cardiovasc Eng Technol 2(4):324–333. doi:10.1007/s13239-011-0052-8

    Article  Google Scholar 

  • Wang Q, Sirois E, Sun W (2012) Patient-specific modeling of biomechanical interaction in transcatheter aortic valve deployment. J Biomech 45(11):1965–1971. doi:10.1016/j.jbiomech.2012.05.008

    Article  Google Scholar 

Download references

Acknowledgments

This work was supported in part by NIH HL104080, HL108239 grants, and AHA predoctoral fellowship 13PRE14830002. We would like to thank Dr. Raymond McKay at the Hartford Hospital, CT for providing the image data. We would also like to thank Caitlin Martin, Thuy Pham, and Kewei Li for providing experimental data of the heart tissues, and technical support provided by Dura Biotech.

Conflict of interest

All authors disclose any financial and personal relationships with other people or organizations that could inappropriately influence (bias) their work.

Author information

Authors and Affiliations

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

    Qian Wang & Wei Sun

  2. Center for Interventional Vascular Therapy, Columbia University College of Physicians and Surgeons, New York, NY, 10032, USA

    Susheel Kodali

  3. Cardiology Department, The Hartford Hospital, Hartford, CT, 06102, USA

    Charles Primiano

Authors
  1. Qian Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Susheel Kodali
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Charles Primiano
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Wei Sun
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei Sun.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Wang, Q., Kodali, S., Primiano, C. et al. Simulations of transcatheter aortic valve implantation: implications for aortic root rupture. Biomech Model Mechanobiol 14, 29–38 (2015). https://doi.org/10.1007/s10237-014-0583-7

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10237-014-0583-7

Keywords

Search

Navigation