Blood Flow Dynamics in the Ascending Aorta of Patients with Bicuspid Aortic Valve Before and After Transcatheter Aortic Valve Replacement: a Computational Fluid Dynamics Study

Overview

Journal BMC Cardiovasc Disord

Publisher Biomed Central

Specialty Cardiology & Vascular Diseases

Date 2024 Dec 20

PMID 39702010

Authors

Kang An

Fengwen Zhang

Wenbin Ouyang

Xiangbin Pan

Affiliations

Soon will be listed here.

Abstract

Background: Abnormal blood flow patterns are known to contribute to the ascending aortic dilation in patients with bicuspid aortic valve (BAV). The present study elucidated the blood flow characteristics in the dilated ascending aorta before and after transcatheter aortic valve replacement (TAVR) using computational fluid dynamics (CFD) analysis.

Methods: We performed CFD analysis in three BAV patients with ascending aortic dilation (maximum diameter ≥ 45 mm) who underwent TAVR. The blood flow streamline was visualized to evaluate the pre- and post-operative flow velocity, severity of vortex and helix, and wall shear stress (WSS) in the ascending aorta.

Results: Before the procedure, all three patients showed abnormal blood flow patterns, with vortex and helix in the ascending aorta. Regionally elevated WSS was also observed in the lateral or posterior ascending aortic wall (16.7 Pa, 12.2 Pa, and 14.5 Pa in patient 1, 2, and 3, respectively). After the procedure, the blood flow patterns significantly improved, and the maximum WSS also decreased (4.2 Pa, 1.1 Pa, and 3.2 Pa in patient 1, 2, and 3, respectively).

Conclusion: Abnormal blood flow patterns and WSS appeared to improve after TAVR in BAV patients with ascending aortic dilation. The impact on the long-term aortic growth rate and the incidence of aortic dissection requires further studies.

Trial Registration: Changes of Ascending Aortic Diameter in Patients Undergoing Transcatheter Aortic Valve Replacement.

Clinicaltrial: gov number NCT05739253. Trial registration date 20,230,212.

References

Verma S, Siu S . Aortic dilatation in patients with bicuspid aortic valve. N Engl J Med. 2014; 370(20):1920-9. DOI: 10.1056/NEJMra1207059. View

Guzzardi D, Barker A, van Ooij P, Malaisrie S, Puthumana J, Belke D . Valve-Related Hemodynamics Mediate Human Bicuspid Aortopathy: Insights From Wall Shear Stress Mapping. J Am Coll Cardiol. 2015; 66(8):892-900. PMC: 4545965. DOI: 10.1016/j.jacc.2015.06.1310. View

Komoriyama H, Kamiya K, Nagai T, Oyama-Manabe N, Tsuneta S, Kobayashi Y . Blood flow dynamics with four-dimensional flow cardiovascular magnetic resonance in patients with aortic stenosis before and after transcatheter aortic valve replacement. J Cardiovasc Magn Reson. 2021; 23(1):81. PMC: 8237445. DOI: 10.1186/s12968-021-00771-y. View

Jorgensen T, Horsted Thyregod H, Ihlemann N, Nissen H, Petursson P, Kjeldsen B . Eight-year outcomes for patients with aortic valve stenosis at low surgical risk randomized to transcatheter vs. surgical aortic valve replacement. Eur Heart J. 2021; 42(30):2912-2919. PMC: 8347457. DOI: 10.1093/eurheartj/ehab375. View

Calo K, Capellini K, De Nisco G, Mazzi V, Gasparotti E, Gallo D . Impact of wall displacements on the large-scale flow coherence in ascending aorta. J Biomech. 2023; 154:111620. DOI: 10.1016/j.jbiomech.2023.111620. View

Guala A, Dux-Santoy L, Teixido-Tura G, Ruiz-Munoz A, Galian-Gay L, Servato M . Wall Shear Stress Predicts Aortic Dilation in Patients With Bicuspid Aortic Valve. JACC Cardiovasc Imaging. 2021; 15(1):46-56. DOI: 10.1016/j.jcmg.2021.09.023. View

Madhavan S, Kemmerling E . The effect of inlet and outlet boundary conditions in image-based CFD modeling of aortic flow. Biomed Eng Online. 2018; 17(1):66. PMC: 5975715. DOI: 10.1186/s12938-018-0497-1. View

An K, Zhang F, Ouyang W, Pan X . Transcatheter aortic valve replacement in patients with preoperative ascending aortic diameter ≥45 mm. Cardiovasc Diagn Ther. 2024; 13(6):939-947. PMC: 10753242. DOI: 10.21037/cdt-23-324. View

Ha H, Koo H, Lee J, Kim G, Kweon J, Lee S . Association between flow skewness and aortic dilatation in patients with aortic stenosis. Int J Cardiovasc Imaging. 2017; 33(12):1969-1978. DOI: 10.1007/s10554-017-1196-x. View

10.

Hanigk M, Burgstaller E, Latus H, Shehu N, Zimmermann J, Martinoff S . Aortic wall shear stress in bicuspid aortic valve disease-10-year follow-up. Cardiovasc Diagn Ther. 2023; 13(1):38-50. PMC: 9971286. DOI: 10.21037/cdt-22-477. View

11.

Nordmeyer S, Hellmeier F, Yevtushenko P, Kelm M, Lee C, Lehmann D . Abnormal aortic flow profiles persist after aortic valve replacement in the majority of patients with aortic valve disease: how model-based personalized therapy planning could improve results. A pilot study approach. Eur J Cardiothorac Surg. 2019; 57(1):133-141. DOI: 10.1093/ejcts/ezz149. View

12.

Rodriguez-Palomares J, Dux-Santoy L, Guala A, Galian-Gay L, Evangelista A . Mechanisms of Aortic Dilation in Patients With Bicuspid Aortic Valve: JACC State-of-the-Art Review. J Am Coll Cardiol. 2023; 82(5):448-464. DOI: 10.1016/j.jacc.2022.10.042. View

13.

Edlin J, Nowell J, Arthurs C, Figueroa A, Jahangiri M . Assessing the methodology used to study the ascending aorta haemodynamics in bicuspid aortic valve. Eur Heart J Digit Health. 2023; 2(2):271-278. PMC: 9707862. DOI: 10.1093/ehjdh/ztab022. View

14.

Hope M, Hope T, Meadows A, Ordovas K, Urbania T, Alley M . Bicuspid aortic valve: four-dimensional MR evaluation of ascending aortic systolic flow patterns. Radiology. 2010; 255(1):53-61. DOI: 10.1148/radiol.09091437. View

15.

Jarral O, Tan M, Salmasi M, Pirola S, Pepper J, ORegan D . Phase-contrast magnetic resonance imaging and computational fluid dynamics assessment of thoracic aorta blood flow: a literature review. Eur J Cardiothorac Surg. 2019; 57(3):438-446. DOI: 10.1093/ejcts/ezz280. View

16.

Otto C, Nishimura R, Bonow R, Carabello B, Erwin 3rd J, Gentile F . 2020 ACC/AHA Guideline for the Management of Patients With Valvular Heart Disease: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. Circulation. 2020; 143(5):e72-e227. DOI: 10.1161/CIR.0000000000000923. View

17.

Ahmad Y, Howard J, Arnold A, Madhavan M, Cook C, Alu M . Transcatheter versus surgical aortic valve replacement in lower-risk and higher-risk patients: a meta-analysis of randomized trials. Eur Heart J. 2023; 44(10):836-852. DOI: 10.1093/eurheartj/ehac642. View

18.

Zhou D, Pan W, Wang J, Wu Y, Chen M, Modine T . VitaFlow™ transcatheter valve system in the treatment of severe aortic stenosis: One-year results of a multicenter study. Catheter Cardiovasc Interv. 2019; 95(2):332-338. DOI: 10.1002/ccd.28226. View

19.

Trauzeddel R, Lobe U, Barker A, Gelsinger C, Butter C, Markl M . Blood flow characteristics in the ascending aorta after TAVI compared to surgical aortic valve replacement. Int J Cardiovasc Imaging. 2015; 32(3):461-7. PMC: 4886550. DOI: 10.1007/s10554-015-0792-x. View

20.

Hope M, Wrenn J, Sigovan M, Foster E, Tseng E, Saloner D . Imaging biomarkers of aortic disease: increased growth rates with eccentric systolic flow. J Am Coll Cardiol. 2012; 60(4):356-7. DOI: 10.1016/j.jacc.2012.01.072. View