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Computational fluid–structure analysis of the impact of leaflet thickness and protrusion height on the flutter phenomenon in aortic valve bioprostheses

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Abstract

Although it is associated with the low lifetime of aortic valve bioprostheses, flutter has little been studied in the dynamics of these valves. To improve the understanding of flutter in bioprosthetic leaflets, the present work evaluates the effect of leaflet thickness and protrusion height on flutter parameters through the computational fluid–structure interaction. A bioprosthesis geometry, based on a geometric model available in the literature, and a simplified fluid domain were developed. As a boundary condition, a parabolic velocity profile was applied at the inlet, outflow at the outlet, and fixed support at the sides of the leaflets. The valve cusps were considered with linear elastic and isotropic mechanical behavior, while the blood was modeled as a Newtonian fluid. Turbulence was modeled according to the k-\(\omega \) SST model. The numerical results showed that, due to the occurrence of leaflet oscillations, both fluid dynamic quantities, such as pressure, velocity, and turbulence intensity, and solid domain quantities, such as stress and strain, exhibited an irregular and oscillatory behavior. Furthermore, the radial displacements of the leaflets were asynchronous, and the phase difference between the leaflets increased with increasing thickness. The frequencies ranged from 28.3 to 36.7 Hz, while the amplitudes ranged from 5.34 to 6.53 mm, where the valve with the lowest protrusion height did not develop flutter

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References

  1. Sotiropoulos F, Le TB, Gilmanov A (2016) Fluid mechanics of heart valves and their replacements. Annu Rev Fluid Mech 48:259–283

    Article  MathSciNet  Google Scholar 

  2. Xu F, Johnson EL, Wang C, Jafari A, Yang C-H, Sacks MS, Krishnamurthy A, Hsu M-C (2021) Computational investigation of left ventricular hemodynamics following bioprosthetic aortic and mitral valve replacement. Mech Res Commun 112:103604

    Article  Google Scholar 

  3. Chen Y, Luo H (2020) Pressure distribution over the leaflets and effect of bending stiffness on fluid-structure interaction of the aortic valve. J Fluid Mech 883:52

    Article  MathSciNet  Google Scholar 

  4. Avelar AHF, Canestri JA, Bim C, Silva MG, Huebner R, Pinotti M (2017) Quantification and analysis of leaflet flutter on biological prosthetic cardiac valves. Artif Organs 41(9):835–844

    Article  Google Scholar 

  5. Hasan A, Ragaert K, Swieszkowski W, Selimović Š, Paul A, Camci-Unal G, Mofrad MR, Khademhosseini A (2014) Biomechanical properties of native and tissue engineered heart valve constructs. J Biomech 47(9):1949–1963

    Article  Google Scholar 

  6. Oveissi F, Naficy S, Lee A, Winlaw D, Dehghani F (2020) Materials and manufacturing perspectives in engineering heart valves: a review. Mater Today Bio 5:100038

    Article  Google Scholar 

  7. Borazjani I (2013) Fluid-structure interaction, immersed boundary-finite element method simulations of bio-prosthetic heart valves. Comput Methods Appl Mech Eng 257:103–116

    Article  MathSciNet  Google Scholar 

  8. Bhagra CJ, D’Souza R, Silversides CK (2017) Valvular heart disease and pregnancy part ii: management of prosthetic valves. Heart 103(3):244–252

    Article  Google Scholar 

  9. Zakerzadeh R, Hsu M-C, Sacks MS (2017) Computational methods for the aortic heart valve and its replacements. Expert Rev Med Dev 14(11):849–866

    Article  Google Scholar 

  10. Becsek B, Pietrasanta L, Obrist D (2020) Turbulent systolic flow downstream of a bioprosthetic aortic valve: velocity spectra, wall shear stresses, and turbulent dissipation rates. Front Physiol 11:577188

    Article  Google Scholar 

  11. Coulter FB, Schaffner M, Faber JA, Rafsanjani A, Smith R, Appa H, Zilla P, Bezuidenhout D, Studart AR (2019) Bioinspired heart valve prosthesis made by silicone additive manufacturing. Matter 1(1):266–279

    Article  Google Scholar 

  12. Cai L, Zhang R, Li Y, Zhu G, Ma X, Wang Y, Luo X, Gao H (2021) The comparison of different constitutive laws and fiber architectures for the aortic valve on fluid–structure interaction simulation. Front Physiol 12:682893

    Article  Google Scholar 

  13. Tayama E, Saku K, Anegawa T, Oryoji A, Negoto S (2022) Prosthetic cardiac valves: history and review of cardiac prostheses clinically available in Japan. Surg Today 52(4):521–531

    Article  Google Scholar 

  14. Rahmani B, McGregor C, Byrne G, Burriesci G (2019) A durable porcine pericardial surgical bioprosthetic heart valve: a proof of concept. JCTR 12:331–337

    Google Scholar 

  15. Lee JH, Scotten LN, Hunt R, Caranasos TG, Vavalle JP, Griffith BE (2021) Bioprosthetic aortic valve diameter and thickness are directly related to leaflet fluttering: results from a combined experimental and computational modeling study. JTCVS open 6:60–81

    Article  Google Scholar 

  16. Simionescu DT, Chen J, Jaeggli M, Wang B, Liao J et al (2012) Form follows function: advances in trilayered structure replication for aortic heart valve tissue engineering. J Healthc Eng 3:179–202

    Article  Google Scholar 

  17. Avelar AHF, Stófel MAGE, Vieira GD, Canestri JA, Huebner R (2020) Analysis of leaflet flutter in biological prosthetic heart valves using piv measurements. Acta Sci Technol 42

  18. Zhu Y, Wilkerson RJ, Pandya PK, Mullis DM, Wu CA, Madira S, Marin-Cuartas M, Park MH, Imbrie-Moore AM, Woo YJ (2023) Biomechanical engineering analysis of pulmonary valve leaflet hemodynamics and kinematics in the ross procedure. J Biomech Eng 145(1):011005

    Article  Google Scholar 

  19. Johnson EL, Wu MC, Xu F, Wiese NM, Rajanna MR, Herrema AJ, Ganapathysubramanian B, Hughes TJ, Sacks MS, Hsu M-C (2020) Thinner biological tissues induce leaflet flutter in aortic heart valve replacements. PNAS 117(32):19007–19016

    Article  Google Scholar 

  20. Johnson EL, Rajanna MR, Yang C-H, Hsu M-C (2022) Effects of membrane and flexural stiffnesses on aortic valve dynamics: identifying the mechanics of leaflet flutter in thinner biological tissues. Forces Mech 6:100053

    Article  Google Scholar 

  21. Chai Y, Gao W, Ankay B, Li F, Zhang C (2021) Aeroelastic analysis and flutter control of wings and panels: a review. Int J Mech Sci 1(1):5–34

    Google Scholar 

  22. De Hart J, Peters G, Schreurs P, Baaijens F (2004) Collagen fibers reduce stresses and stabilize motion of aortic valve leaflets during systole. J Biomech 37(3):303–311

    Article  Google Scholar 

  23. Grigioni M, Daniele C, D’avenio G, Barbaro V (2000) Laser doppler anemometry study of bidimensional flows downstream of three 19 mm bileaflet valves in the mitral position, under kinematic similarity. Ann Biomed Eng 28:194–203

    Article  Google Scholar 

  24. Tsolaki E, Corso P, Zboray R, Avaro J, Appel C, Liebi M, Bertazzo S, Heinisch PP, Carrel T, Obrist D, et al (2023) Multiscale multimodal characterization and simulation of structural alterations in failed bioprosthetic heart valves. bioRxiv, 2023–02

  25. Mintz GS, Carlson EB, Kotler MN (1982) Comparison of noninvasive techniques in evaluation of the nontissue cardiac valve prosthesis. Am J Cardiol 49(1):39–44

    Article  Google Scholar 

  26. Pinto ER, Damani PM, Sternberg CN, Liedtke A (1978) Fine flutterings of the aortic valve as demonstrated by aortic valve echocardiograms. Am Heart J 95(6):807–808

    Article  Google Scholar 

  27. Sze KC, Nanda NC, Gramiak R (1978) Systolic flutter of the mitral valve. Am Heart J 96(2):157–162

    Article  Google Scholar 

  28. Sigüenza J, Pott D, Mendez S, Sonntag SJ, Kaufmann TA, Steinseifer U, Nicoud F (2018) Fluid-structure interaction of a pulsatile flow with an aortic valve model: a combined experimental and numerical study. Int J Numer Methods Biomed 34(4):2945

    Article  MathSciNet  Google Scholar 

  29. Nestola MG, Zulian P, Gaedke-Merzhäuser L, Krause R (2021) Fully coupled dynamic simulations of bioprosthetic aortic valves based on an embedded strategy for fluid-structure interaction with contact. EP Europace 23(Supplement 1):96–104

    Article  Google Scholar 

  30. Ma X, Gao B, Tao L, Ding J, Li S, Qiao A, Chang Y (2022) Hemodynamic study of the effect of the geometric height of leaflets on the performance of the aortic valve under aortic valve reconstruction. J Thorac Dis 14(5):1515

    Article  Google Scholar 

  31. Morany A, Lavon K, Gomez Bardon R, Kovarovic B, Hamdan A, Bluestein D, Haj-Ali R (2023) Fluid-structure interaction modeling of compliant aortic valves using the lattice Boltzmann CFD and fem methods. Biomech Model Mechanobiol 22:837–850

    Article  Google Scholar 

  32. Sadrabadi MS, Hedayat M, Borazjani I, Arzani A (2021) Fluid-structure coupled biotransport processes in aortic valve disease. J Biomech 117:110239

    Article  Google Scholar 

  33. Pasta S, Cannata S, Gentile G, Di Giuseppe M, Cosentino F, Pasta F, Agnese V, Bellavia D, Raffa GM, Pilato M et al (2020) Simulation study of transcatheter heart valve implantation in patients with stenotic bicuspid aortic valve. Med Biol Eng Comput 58:815–829

    Article  Google Scholar 

  34. Bavo AM, Rocatello G, Iannaccone F, Degroote J, Vierendeels J, Segers P (2016) Fluid-structure interaction simulation of prosthetic aortic valves: comparison between immersed boundary and arbitrary lagrangian-eulerian techniques for the mesh representation. PLoS ONE 11(4):0154517

    Article  Google Scholar 

  35. Abbasi M, Azadani AN (2020) A geometry optimization framework for transcatheter heart valve leaflet design. J Mech Behav Biomed Mater 102:103491

    Article  Google Scholar 

  36. Cao K, Bukač M, Sucosky P (2016) Three-dimensional macro-scale assessment of regional and temporal wall shear stress characteristics on aortic valve leaflets. Comput Methods Biomech Biomed Engin 19(6):603–613

    Article  Google Scholar 

  37. Koch T, Reddy B, Zilla P, Franz T (2010) Aortic valve leaflet mechanical properties facilitate diastolic valve function. Comput Methods Biomech Biomed Engin 13(2):225–234

    Article  Google Scholar 

  38. Martin C, Sun W (2015) Comparison of transcatheter aortic valve and surgical bioprosthetic valve durability: a fatigue simulation study. J Biomech 48(12):3026–3034

    Article  Google Scholar 

  39. Tango AM, Salmonsmith J, Ducci A, Burriesci G (2018) Validation and extension of a fluid-structure interaction model of the healthy aortic valve. CVET 9:739–751

    Google Scholar 

  40. Amindari A, Saltik L, Kirkkopru K, Yacoub M, Yalcin HC (2017) Assessment of calcified aortic valve leaflet deformations and blood flow dynamics using fluid-structure interaction modeling. IMU 9:191–199

    Google Scholar 

  41. Mutlu O, Salman HE, Yalcin HC, Olcay AB (2021) Fluid flow characteristics of healthy and calcified aortic valves using three-dimensional Lagrangian coherent structures analysis. Fluids 6(6):203

    Article  Google Scholar 

  42. Silva MLF, Gonçalves SF, Costa MCB, Huebner R, Navarro TP (2023) Structural numerical analysis of a branched modular stent-graft for aneurysms encompassing all zones of the aortic arch. J Mech Behav Biomed Mater 147:106135

    Article  Google Scholar 

  43. Borowski F, Ott R, Oldenburg J, Kaule S, Öner A, Schmitz K-P, Stiehm M (2022) Validation of a fluid structure interaction model for tavr using particle image velocimetry. In: CDBME, vol 8, pp 512–515. De Gruyter

  44. Ghosh RP, Marom G, Rotman OM, Slepian MJ, Prabhakar S, Horner M, Bluestein D (2018) Comparative fluid-structure interaction analysis of polymeric transcatheter and surgical aortic valves’ hemodynamics and structural mechanics. J Biomech Eng 140(12):121002

    Article  Google Scholar 

  45. Gilmanov A, Barker A, Stolarski H, Sotiropoulos F (2019) Image-guided fluid-structure interaction simulation of transvalvular hemodynamics: quantifying the effects of varying aortic valve leaflet thickness. Fluids 4(3):119

    Article  Google Scholar 

  46. Luraghi G, Migliavacca F, Rodriguez Matas JF (2018) Study on the accuracy of structural and FSI heart valves simulations. CVET 9:723–738

    Google Scholar 

  47. Luraghi G, Migliavacca F, Chiastra C, Rossi A, Reimers B, Stefanini GG, Matas JFR (2019) Does clinical data quality affect fluid-structure interaction simulations of patient-specific stenotic aortic valve models? J Biomech 94:202–210

    Article  Google Scholar 

  48. Lucas TC, Tessarolo F, Jakitsch V, Caola I, Brunori G, Nollo G, Huebner R (2014) Blood flow in hemodialysis catheters: a numerical simulation and microscopic analysis of in vivo-formed fibrin. Artif Organs 38(7):556–565

    Article  Google Scholar 

  49. Singh R, Strom JA, Ondrovic L, Joseph B, VanAuker MD (2008) Age-related changes in the aortic valve affect leaflet stress distributions: implications for aortic valve degeneration. J Heart Valve Dis 17(3):290

    Google Scholar 

  50. Salman HE, Saltik L, Yalcin HC (2021) Computational analysis of wall shear stress patterns on calcified and bicuspid aortic valves: Focus on radial and coaptation patterns. Fluids 6(8):287

    Article  Google Scholar 

  51. Borowski F, Sämann M, Pfensig S, Wüstenhagen C, Ott R, Kaule S, Siewert S, Grabow N, Schmitz K-P, Stiehm M (2018) Fluid-structure interaction of heart valve dynamics in comparison to finite-element analysis. CDBME 4(1):259–262

    Google Scholar 

  52. Joda A, Jin Z, Summers J, Korossis S (2019) Comparison of a fixed-grid and arbitrary Lagrangian–Eulerian methods on modelling fluid-structure interaction of the aortic valve. Proc Inst Mech Eng H J Eng Med 233(5):544–553

    Article  Google Scholar 

  53. Saleeb A, Kumar A, Thomas V (2013) The important roles of tissue anisotropy and tissue-to-tissue contact on the dynamical behavior of a symmetric tri-leaflet valve during multiple cardiac pressure cycles. Med Eng Phys 35(1):23–35

    Article  Google Scholar 

  54. Emendi M, Sturla F, Ghosh RP, Bianchi M, Piatti F, Pluchinotta FR, Giese D, Lombardi M, Redaelli A, Bluestein D (2021) Patient-specific bicuspid aortic valve biomechanics: a magnetic resonance imaging integrated fluid-structure interaction approach. Ann Biomed Eng 49:627–641

    Article  Google Scholar 

  55. Wald S, Liberzon A, Avrahami I (2018) A numerical study of the hemodynamic effect of the aortic valve on coronary flow. Biomech Model Mechanobiol 17:319–338

    Article  Google Scholar 

  56. Gharaie SH (2016) A novel design and optimization of a polymeric aortic valve using numerical and experimental techniques. PhD thesis, Swinburne University of Technology

  57. Lavon K, Morany A, Halevi R, Hamdan A, Raanani E, Bluestein D, Haj-Ali R (2021) Progressive calcification in bicuspid valves: a coupled hemodynamics and multiscale structural computations. Ann Biomed Eng 49:3310–3322

    Article  Google Scholar 

  58. Kivi AR, Sedaghatizadeh N, Cazzolato BS, Zander AC, Roberts-Thomson R, Nelson AJ, Arjomandi M (2020) Fluid structure interaction modelling of aortic valve stenosis: effects of valve calcification on coronary artery flow and aortic root hemodynamics. Comput Methods Programs Biomed 196:105647

    Article  Google Scholar 

  59. Zhou H, Zhong K, Jia H, Kang Y (2022) Analysis of the effects of dynamic mesh update method on simulating indoor airflow induced by moving objects. Build Environ 212:108782

    Article  Google Scholar 

  60. Rhie CM, Chow W-L (1983) Numerical study of the turbulent flow past an airfoil with trailing edge separation. AIAA J 21(11):1525–1532

    Article  Google Scholar 

  61. Issa RI (1986) Solution of the implicitly discretised fluid flow equations by operator-splitting. J Comput Phys 62(1):40–65

    Article  MathSciNet  Google Scholar 

  62. Silva MLF, Freitas Gonçalves S, Huebner R (2022) Comparative study of arterial wall models for numerical fluid-structure interaction simulation of aortic arch aneurysms. J Braz Soc Mech Sci Eng 44(5):172

    Article  Google Scholar 

  63. Vennemann B, Rösgen T, Heinisch PP, Obrist D (2018) Leaflet kinematics of mechanical and bioprosthetic aortic valve prostheses. ASAIO J 64(5):651–661

    Article  Google Scholar 

  64. Aljalloud A, Shoaib M, Egron S, Arias J, Tewarie L, Schnoering H, Lotfi S, Goetzenich A, Hatam N, Pott D et al (2018) The flutter-by effect: a comprehensive study of the fluttering cusps of the perceval heart valve prosthesis. ICVTS 27(5):664–670

    Google Scholar 

  65. Hatoum H, Dollery J, Lilly SM, Crestanello JA, Dasi LP (2018) Effect of severe bioprosthetic valve tissue ingrowth and inflow calcification on valve-in-valve performance. J Biomech 74:171–179

    Article  Google Scholar 

  66. Mao W, Li K, Sun W (2016) Fluid-structure interaction study of transcatheter aortic valve dynamics using smoothed particle hydrodynamics. CVET 7:374–388

    Google Scholar 

  67. Juvinall R, Marshek K (2012) Fundamentos do Projeto de Componentes de Máquinas. Grupo Gen-LTC, Rio de Janeiro

    Google Scholar 

  68. Joda A, Jin Z, Haverich A, Summers J, Korossis S (2016) Multiphysics simulation of the effect of leaflet thickness inhomogeneity and material anisotropy on the stress-strain distribution on the aortic valve. J Biomech 49(12):2502–2512

    Article  Google Scholar 

  69. May-Newman K, Lam C, Yin FCP (2009) A hyperelastic constitutive law for aortic valve tissue. J Biomech Eng 131(8):081009

    Article  Google Scholar 

  70. Soares JS, Feaver KR, Zhang W, Kamensky D, Aggarwal A, Sacks MS (2016) Biomechanical behavior of bioprosthetic heart valve heterograft tissues: characterization, simulation, and performance. CVET 7:309–351

    Google Scholar 

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Acknowledgements

The authors would like to thank Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG (APQ-02824-21) for their support in this project. This study was financed in part by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior - Brasil (CAPES) - Finance Code 001.

Funding

This study was funded by Fundação de Amparo à Pesquisa do Estado de Minas Gerais - FAPEMIG (APQ-02824-21).

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Matheus Carvalho Barbosa Costa: Writing - review and editing, Writing - original draft, Validation, Software, Project administration, Methodology, Investigation, Formal analysis, Data curation, Conceptualization; Saulo de Freitas Gonçalves: Writing - original draft, Validation, Methodology, Investigation, Formal analysis, Data curation; João Victor Curado Fleury: Writing - review and editing, Validation, Software, Methodology, Investigation, Formal analysis; Mário Luis Ferreira da Silva: Writing - review and editing, Validation, Software, Methodology, Investigation, Formal analysis; Rudolf Huebner: Writing - review and editing, Supervision, Resources, Project administration, Methodology, Conceptualization, Funding acquisition, Resources; Artur Henrique de Freitas Avelar: Writing - review and editing, Validation, Software, Methodology, Investigation, Formal analysis.

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Costa, M.C.B., Gonçalves, S.d.F., Fleury, J.V.C. et al. Computational fluid–structure analysis of the impact of leaflet thickness and protrusion height on the flutter phenomenon in aortic valve bioprostheses. Meccanica 59, 685–701 (2024). https://doi.org/10.1007/s11012-024-01809-y

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