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Effect of Ascending Aortic Curvature on Flow in the Sinus and Neo-sinus Following TAVR: A Patient-Specific Study

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Abstract

Patient-specific aortic geometry and its influence on the flow in the vicinity of Transcatheter Aortic Valve (TAV) has been highlighted in numerous studies using both in silico and in vitro experiments. However, there has not yet been a detailed Particle Image Velocimetry (PIV) experiment conducted to quantify the relationship between the geometry, flow downstream of TAV, and the flow in the sinus and the neo-sinus. We tested six different patient-specific aorta models with a 26-mm SAPIEN 3 valve (Edwards Lifesciences, Irvine, CA, USA) in a left heart simulator with coronary flow. Velocities in all three cusps and circulation downstream of TAV were computed to evaluate the influence of the ascending aorta curvature on the flow field. The in vitro analysis showed that the patient-specific aortic curvature had positive correlation to the circulation in the ascending aorta (p = 0.036) and circulation had negative correlation to the particle washout time in the cusps (p = 0.011). These results showed that distinct vortical flow patterns in the ascending aorta as the main jet impinges on the aortic wall causes a recirculation region that facilitates the flow back into the sinus and the neo-sinus, thus reducing the risk of flow stagnation and washout time.

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Abbreviations

THV:

Transcatheter heart valve

TAV:

Transcatheter aortic valve

TAVR:

Transcatheter aortic valve replacement

LCC:

Left coronary cusp

RCC:

Right coronary cusp

NCC:

Non-coronary cusp

PIV:

Particle image velocimetry

STJ:

Sino tubular junction

TVPG:

Transvalvular pressure gradient

LCA:

Left coronary artery

RCA:

Right coronary artery

LVOT:

Left ventricular outflow tract

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Acknowledgements

The authors would like to thank the anonymous reviewer for providing constructive feedback that has improved the quality of the manuscript substantially. The authors also acknowledge the members of the Cardiovascular Fluid Mechanics Laboratory (CFML) of Georgia Institute of Technology, especially Dr. Thangam Natarajan, for their assistance. Lastly, the authors also appreciate Drs. Beatrice Ncho, Phillip Trusty and Yajun Mei for valuable feedback on the paper.

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Authors and Affiliations

  1. Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, GA, USA

    Jae Hyun Kim, Vahid Sadri, Huang Chen, Sanchita Bhat, Keshav Kohli & Ajit P. Yoganathan

  2. Cedars-Sinai Medical Center, Smidt Heart Institute, Los Angeles, CA, USA

    Raj Makkar

  3. Structural Heart and Valve Center, Emory University Hospital, Atlanta, GA, USA

    Vasilis C. Babaliaros

  4. Division of Cardiovascular Medicine, Stanford University, Stanford, CA, USA

    Rahul P. Sharma

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  1. Jae Hyun Kim
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Correspondence to Ajit P. Yoganathan.

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Conflict of interest

Raj Makkar, receives research grants from Edwards Lifesciences, Medtronic, Abbott Vascular, Cordis, and St. Jude Medical; and is proctor for Edwards Lifesciences and a consultant to Medtronic. Vasilis C. Babaliaros, has served as a consultant for Edwards Lifesciences and Abbott Vascular; and has served as a consultant for and is an equity holder in Transmural Systems. Rahul P. Sharma, is a consultant or researcher for Edwards Lifesciences, Boston Scientific, Keystone Heart, and Abbott. All other authors reported no conflicts of interest.

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Kim, J.H., Sadri, V., Chen, H. et al. Effect of Ascending Aortic Curvature on Flow in the Sinus and Neo-sinus Following TAVR: A Patient-Specific Study. Ann Biomed Eng 52, 425–439 (2024). https://doi.org/10.1007/s10439-023-03392-x

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