Transcatheter aortic valve replacement improved abnormal blood flow patterns and substantially decreased maximum wall shear stress from 12.2-16.7 Pa to 1.1-4.2 Pa in three patients with bicuspid aortic valve and ascending aortic dilation.
Observational (n=3)
No
Does transcatheter aortic valve replacement improve blood flow patterns and wall shear stress in patients with bicuspid aortic valve and ascending aortic dilation?
TAVR significantly improves abnormal blood flow patterns and reduces wall shear stress in the dilated ascending aorta of patients with bicuspid aortic valve.
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.
An et al. (Thu,) conducted a observational in Bicuspid aortic valve with ascending aortic dilation (n=3). Transcatheter aortic valve replacement (TAVR) vs. Pre-operative baseline was evaluated on Blood flow patterns and maximum wall shear stress (WSS) in the ascending aorta. Transcatheter aortic valve replacement improved abnormal blood flow patterns and substantially decreased maximum wall shear stress from 12.2-16.7 Pa to 1.1-4.2 Pa in three patients with bicuspid aortic valve and ascending aortic dilation.
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