Thinner biological tissues induce leaflet flutter in aortic heart valve replacements

Proc Natl Acad Sci U S A. 2020 Aug 11;117(32):19007-19016. doi: 10.1073/pnas.2002821117. Epub 2020 Jul 24.

Abstract

Valvular heart disease has recently become an increasing public health concern due to the high prevalence of valve degeneration in aging populations. For patients with severely impacted aortic valves that require replacement, catheter-based bioprosthetic valve deployment offers a minimally invasive treatment option that eliminates many of the risks associated with surgical valve replacement. Although recent percutaneous device advancements have incorporated thinner, more flexible biological tissues to streamline safer deployment through catheters, the impact of such tissues in the complex, mechanically demanding, and highly dynamic valvular system remains poorly understood. The present work utilized a validated computational fluid-structure interaction approach to isolate the behavior of thinner, more compliant aortic valve tissues in a physiologically realistic system. This computational study identified and quantified significant leaflet flutter induced by the use of thinner tissues that initiated blood flow disturbances and oscillatory leaflet strains. The aortic flow and valvular dynamics associated with these thinner valvular tissues have not been previously identified and provide essential information that can significantly advance fundamental knowledge about the cardiac system and support future medical device innovation. Considering the risks associated with such observed flutter phenomena, including blood damage and accelerated leaflet deterioration, this study demonstrates the potentially serious impact of introducing thinner, more flexible tissues into the cardiac system.

Keywords: fluid–structure interaction; heart valves; immersogeometric analysis; leaflet flutter; thin biological tissues.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Animals
  • Aortic Valve / anatomy & histology
  • Aortic Valve / chemistry*
  • Aortic Valve / physiopathology
  • Aortic Valve / surgery
  • Biomechanical Phenomena
  • Cattle
  • Heart Valve Diseases / physiopathology*
  • Heart Valve Diseases / surgery
  • Heart Valve Prosthesis
  • Hemodynamics
  • Humans
  • Models, Cardiovascular