Bioengineering Case Study to Evaluate Complications of Adverse Anatomy of Aortic Root in Transcatheter Aortic Valve Replacement: Combining Biomechanical Modelling with CT imaging

Cristiano Spadaccio; Laura Mazzocchi; Irina Timofeva; Laurent Macron; Carlo Nicola De Cecco; Simone Morganti; Ferdinando Auricchio; Francesco Nappi

doi:10.3390/bioengineering7040121

Bioengineering Case Study to Evaluate Complications of Adverse Anatomy of Aortic Root in Transcatheter Aortic Valve Replacement: Combining Biomechanical Modelling with CT imaging

Bioengineering (Basel). 2020 Oct 1;7(4):121. doi: 10.3390/bioengineering7040121.

Authors

Cristiano Spadaccio^{1

2}, Laura Mazzocchi³, Irina Timofeva⁴, Laurent Macron⁴, Carlo Nicola De Cecco⁵, Simone Morganti⁶, Ferdinando Auricchio³, Francesco Nappi⁷

Affiliations

¹ Department of Cardiothoracic Surgery, Golden Jubilee National Hospital, Clydebank G81 4DY, UK.
² University of Glasgow, Institute of Cardiovascular and Medical Sciences, Glasgow G12 8TA, UK.
³ Department of Civil Engineering and Architecture, University of Pavia, 27100 Pavia, Italy.
⁴ Department of Imaging, Centre Cardiologique du Nord de Saint-Denis, 93200 St Denis, France.
⁵ Division of Cardiothoracic Imaging, Nuclear Medicine and Molecular Imaging, Department of Radiology and Imaging Sciences, Emory University Hospital|Emory Healthcare, 1364 Clifton Road Northeast, Atlanta, GA 30322, USA.
⁶ Department of Electrical, Computer and Biomedical Engineering, University of Pavia, 27100 Pavia, Italy.
⁷ Department of Cardiac Surgery, Centre Cardiologique du Nord de Saint-Denis, 93200 St. Denis, France.

Abstract

Gated computed tomography (CT) might not adequately predict occurrence of post-implantation transcatheter aortic valve replacement (TAVR) complications in hostile aortic root as it would require a more complex integration of morphological, functional and hemodynamical parameters. We used a computational framework based on finite element analysis (FEA) to simulate patient-specific implantation. Application of biomechanical modelling using FEA to gated-CT was able to demonstrate the relation of the device with voluminous calcification, its consequent misalignment and a significant stent deformation. Use of FEA and other advanced computed predictive modelling techniques as an adjunct to CT scan could improve our understanding of TAVR, potentially predict complications and fate of the devices after implantation and inform patient-specific treatment.

Keywords: biomechanical modelling; calcification; complications; finite element analysis (FEA); transcatheter aortic valve replacement (TAVR).