NDLI: Transcatheter Valve Underexpansion Limits Leaflet Durability: Implications for Valve-in-Valve Procedures

Content Provider	Springer Nature Link
Author	Martin, Caitlin Sun, Wei
Copyright Year	2016
Abstract	Transcatheter aortic valve (TAV) implantation within a failed bioprosthetic valve is a growing trend for high-risk patients. The non-compliant stent of the previous prosthesis may prevent full expansion of the TAV, which has been shown to distort the leaflet configuration, and has been hypothesized to adversely affect durability. In this study, TAV leaflet fatigue damage under cyclic pressurization in the setting of stent underexpansion by 0 (fully expanded), 1, 2 and 3 mm was simulated using finite element analysis to test this hypothesis. In the 2 and 3 mm underexpanded devices, the TAV leaflets exhibited severe pin-wheeling during valve closure, which increased leaflet stresses dramatically, and resulted in accelerated fatigue damage of the leaflets. The leaflet fatigue damage in the 1 mm underexpanded case was similar to that in the fully expanded case. Clinically a range of 10–15% underexpansion is generally considered acceptable; however, it was observed in this study that ≥2 mm (≥9.1%) underexpansion, will significantly impact device durability. Further study is necessary to determine the impact of various deployment conditions, i.e. non-uniform and non-circular deployments and different implantation heights, on differing TAV devices, but it is clear that the normal TAV leaflet configuration must be preserved in order to preserve durability.
Starting Page	394
Ending Page	404
Page Count	11
File Format	PDF
ISSN	00906964
Journal	Annals of Biomedical Engineering
Volume Number	45
Issue Number	2
e-ISSN	15739686
Language	English
Publisher	Springer US
Publisher Date	2016-10-12
Publisher Place	New York
Access Restriction	One Nation One Subscription (ONOS)
Subject Keyword	Valve-in-valve Transcatheter aortic valve Stent underexpansion Soft tissue fatigue damage Finite element analysis Biomedicine Biomedical Engineering Biological and Medical Physics, Biophysics Classical Mechanics Biochemistry
Content Type	Text
Resource Type	Article
Subject	Biomedical Engineering

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