Comparison of hemodynamics in biological surgical aortic valve replacement and transcatheter aortic valve implantation: An in‐silico study

• Published in: Artificial organs 2023-02, Vol.47 (2), p.352-360
• Main Authors: Franke, Benedikt, Schlief, Adriano, Walczak, Lars, Sündermann, Simon, Unbehaun, Axel, Kempfert, Jörg, Solowjowa, Natalia, Kühne, Titus, Goubergrits, Leonid
• Format: Article
• Language: English
• Subjects: Aorta; Aortic stenosis; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - surgery; Aortic Valve Stenosis - surgery; Computed tomography; Flow velocity; Heart Valve Prosthesis Implantation - adverse effects; Heart valves; Hemodynamics; Humans; Mathematical models; Numerical methods; Patients; Prostheses; Risk Factors; Shear stress; surgical aortic valve replacement; TAVI; Transcatheter Aortic Valve Replacement - adverse effects; Treatment Outcome; Ventricle; virtual treatment; Volumetric analysis; Wall shear stresses
• ISSN: 0160-564X; 1525-1594
• DOI: 10.1111/aor.14405

Objectives In aortic valve replacement (AVR), the treatment strategy as well as the model and size of the implanted prosthesis have a major impact on the postoperative hemodynamics and thus on the clinical outcome. Preinterventional prediction of the hemodynamics could support the treatment decision. Therefore, we performed paired virtual treatment with transcatheter AVR (TAVI) and biological surgical AVR (SAVR) and compared hemodynamic outcomes using numerical simulations. Methods 10 patients with severe aortic stenosis (AS) undergoing TAVI were virtually treated with both biological SAVR and TAVI to compare post‐interventional hemodynamics using numerical simulations of peak‐systolic flow. Virtual treatment procedure was done using an in‐house developed tool based on position‐based dynamics methodology, which was applied to the patient's anatomy including LVOT, aortic root and aorta. Geometries were automatically segmented from dynamic CT‐scans and patient‐specific flow rates were calculated by volumetric analysis of the left ventricle. Hemodynamics were assessed using the STAR CCM+ software by solving the RANS equations. Results Virtual treatment with TAVI resulted in realistic hemodynamics comparable to echocardiographic measurements (median difference in transvalvular pressure gradient [TPG]: −0.33 mm Hg). Virtual TAVI and SAVR showed similar hemodynamic functions with a mean TPG with standard deviation of 8.45 ± 4.60 mm Hg in TAVI and 6.66 ± 3.79 mm Hg in SAVR (p = 0.03) while max. Wall shear stress being 12.6 ± 4.59 vs. 10.2 ± 4.42 Pa (p = 0.001). Conclusions Using the presented method for virtual treatment of AS, we were able to reliably predict post‐interventional hemodynamics. TAVI and SAVR show similar hemodynamics in a pairwise comparison. We performed virtual treatment with TAVI and biological SAVR in 10 patients with aortic stenosis and compared post‐interventional hemodynamics using computational fluid dynamics. Both treatments resulted in good outcomes with comparable figures for TPG and WSS, with SAVR performing slightly better. Our study was motivated by the recent adjustment of the ECS/EACTS guidelines for treatment of aortic stenosis, which no longer advise against TAVI procedure for intermediate‐risk patients, indicating that TAVI and SAVR populations will increasingly overlap in the future.