Evaluation of hemodynamic significance for paraprosthetic fistula after transcatheter aortic valve implantation

Highlights. Using ECHO and MSCT data, a numerical assessment of hemodynamic effects of paraprosthetic regurgitation following transcatheter aortic valve replacement was performed. A significant increase in the fluid flow, wall and viscous shear stresses in the area of regurgitation is shown. The modeling technique described in the paper can be used prospectively in assessing the optimal treatment modality in terms of predicting the quantitative characteristics of the flow, associated with the risks of destruction of red blood cells and thrombosis

Aim. To make a numerical assessment of hemodynamic effects of paraprosthetic regurgitation following transcatheter aortic valve replacement based on retrospective clinical data.

Methods. The study included echocardiography and multi-slice computed tomography data as input data for modeling one pulsation of a fluid similar in properties to blood. Reconstruction of the paraprosthetic fistula and the ascending aorta was performed in the Mimics medium (Materialise, Belgium). The obtained 3D models were processed in the Salome software (OPEN CASCADE SAS, France), after which they were exported to HELYX-OS (ENGYS, Great Britain) to build a finite element mesh. The flows were modeled using the OpenFOAM software package version 6 (The OpenFOAM Foundation Ltd, UK).

Results. The simulation result, expressed quantitatively and qualitatively in the form of diagrams of the measured parameters – fluid flow velocities, wall and viscous shear stresses, shows a significant increase in indicators in the area of paraprosthetic regurgitation. Thus, the velocity in the affected area was 1.9–4.2 m/s, which is 3.8 higher than the average value in the entire computational area. The wall shear stress value was up to 61 Pa in the critical area, which may indicate an increased risk of thrombus formation due to the initiation of the clotting cascade through the von Willebrand factor. The value of viscous shear stress, the main component of the destruction of red blood cells in laminar flow, amounted to 20–26 Pa, which, in general, is not enough for mechanical hemolysis.

Conclusion. The modeling technique described in the paper can be used prospectively in assessing the optimal treatment modality in terms of predicting the quantitative characteristics of the flow, associated with the risks of destruction of red blood cells and thrombosis.

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