Computational study of the balloon dilation steps on transcatheter aortic valve replacement

Jianming Li; Zhuangyuan Meng; Wentao Yan; Wenshuo Wang; Lai Wei; Shengzhang Wang

doi:10.3389/fbioe.2023.1333138

Computational study of the balloon dilation steps on transcatheter aortic valve replacement

Front Bioeng Biotechnol. 2023 Dec 20:11:1333138. doi: 10.3389/fbioe.2023.1333138. eCollection 2023.

Authors

Jianming Li¹, Zhuangyuan Meng¹, Wentao Yan², Wenshuo Wang³, Lai Wei³, Shengzhang Wang^{1

4

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Affiliations

¹ Department of Aeronautics and Astronautics, Institute of Biomechanics, Fudan University, Shanghai, China.
² Shanghai Inspection and Research Institute for Medical Devices, Shanghai, China.
³ Department of Cardiac Surgery, Zhongshan Hospital Affiliated to Fudan University, Shanghai, China.
⁴ Academy for Engineering and Technology, Institute of Biomedical Engineering Technology, Fudan University, Shanghai, China.
⁵ Zhuhai Fudan Innovation Institute, Zhuhai, China.

Abstract

Balloon dilation is a commonly used assistant method in transcatheter aortic valve replacement (TAVR) and plays an important role during valve implantation procedure. The balloon dilation steps need to be fully considered in TAVR numerical simulations. This study aims to establish a TAVR simulation procedure with two different balloon dilation steps to analyze the impact of balloon dilation on the results of TAVR implantation. Two cases of aortic stenosis were constructed based on medical images. An implantation simulation procedure with self-expandable valve was established, and multiple models including different simulation steps such as balloon pre-dilation and balloon post-dilation were constructed to compare the different effects on vascular stress, stent morphology and paravalvular leakage. Results show that balloon pre-dilation of TAVR makes less impact on post-operative outcomes, while post-dilation can effectively improve the implantation morphology of the stent, which is beneficial to the function and durability of the valve. It can effectively improve the adhesion of the stent and reduce the paravalvular leakage volume more than 30% after implantation. However, balloon post-dilation may also lead to about 20% or more increased stress on the aorta and increase the risk of damage. The balloon dilation makes an important impact on the TAVR outcomes. Balloon dilation needs to be fully considered during pre-operative analysis to obtain a better clinical result.

Keywords: numerical simulation; post-dilation; pre-dilation; self-expandable valve; transcatheter aortic valve replacement.

Grants and funding

The author(s) declare financial support was received for the research, authorship, and/or publication of this article. This study was partially supported by National Natural Science Foundation of China (No. 11872152, 32,071,310) and Zhuhai Fudan Innovation Institute.