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

  • Immanuel David Madukauwa-David
  • Vahid Sadri
  • Prem A Midha
  • Vasilis Babaliaros
  • Cyrus Aidun
  • Ajit P. YoganathanEmail author
Article
  • 106 Downloads

Abstract

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.

Keywords

TAVR Coronary flow Neo-sinus Flow Stasis Thrombosis Particle image velocimetry 

Abbreviations

THV

Transcatheter heart valve

LCC

Left coronary cusp

RCC

Right coronary cusp

NCC

Non-coronary cusp

PRT

Particle residence time

IAD

Georgia Tech TAVR intra-annular device

SAD

Georgia Tech TAVR supra-annular device

LCS

Left-coronary sinus

NCS

Non-coronary sinus

STJ

Sino-tubular junction

PIV

Particle image velocimetry

Notes

Acknowledgments

The authors would like to acknowledge the members of the Cardiovascular Fluid Mechanics Laboratory for their assistance and feedback.

Funding

The work at the Cardiovascular Fluid Mechanics Laboratory at the Georgia Institute of Technology was funded through the BME Gurley Foundation and the Mary and James Wesley Fellowship Endowment, as well as discretionary funds made available to the Principal Investigator, such as the Wallace H Coulter Endowed Chair.

Conflict of interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Supplementary material

10439_2019_2324_MOESM1_ESM.tiff (12.1 mb)
Supplementary material 1 Supplementary figure 1: Schematic of the coronary flow module. Components included a piston pump, two check valves, a flow probe, and variable resistance. (TIFF 12383 kb)
10439_2019_2324_MOESM2_ESM.tiff (19.4 mb)
Supplementary material 2 Supplementary figure 2: IAD flow streamlines and velocities for the LCC and NCC neo-sinuses and native sinuses at select time points in systole. (TIFF 19832 kb)
10439_2019_2324_MOESM3_ESM.tiff (19.4 mb)
Supplementary material 3 Supplementary figure 3: SAD flow streamlines and velocities for the LCC and NCC neo-sinuses and native sinuses at select time points in systole. (TIFF 19909 kb)
10439_2019_2324_MOESM4_ESM.tiff (21.3 mb)
Supplementary material 4 Supplementary figure 3: Representative snapshots of particle positions for the LCC of the supra-annular valve. (TIFF 0 kb)

Supplementary material 5 Video 1: Velocity contours and streamlines for the supra-annular valve LCC. (MP4 37794 kb)

Supplementary material 6 Video 2: Velocity contours and streamlines for the intra-annular valve LCC. (MP4 45106 kb)

Supplementary material 7 Video 3: Velocity contours and streamlines for the supra-annular valve NCC. (MP4 25784 kb)

Supplementary material 8 Video 4: Velocity contours and streamlines for the intra-annular valve NCC. (MP4 41932 kb)

10439_2019_2324_MOESM9_ESM.mp4 (28.9 mb)
Supplementary material 9 Video 5: Velocity contours and vectors for the supra-annular valve LCC. (MP4 29595 kb)
10439_2019_2324_MOESM10_ESM.mp4 (25.8 mb)
Supplementary material 10 Video 6: Velocity contours and vectors for the intra-annular valve LCC. (MP4 26463 kb)
10439_2019_2324_MOESM11_ESM.mp4 (22.6 mb)
Supplementary material 11 Video 7: Velocity contours and vectors for the supra-annular valve NCC. (MP4 23158 kb)
10439_2019_2324_MOESM12_ESM.mp4 (25.1 mb)
Supplementary material 12 Video 8: Velocity contours and vectors for the intra-annular valve NCC. (MP4 25668 kb)

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Copyright information

© Biomedical Engineering Society 2019

Authors and Affiliations

  1. 1.Wallace H. Coulter Department of Biomedical EngineeringGeorgia Institute of Technology & Emory UniversityAtlantaUSA
  2. 2.Exponent, Inc.PhiladelphiaUSA
  3. 3.Emory University HospitalAtlantaUSA

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