Key result
Simulated TAVR reduces maximum coronary flow by up to ~23% and increases LV workload.
Why the study?
The long-term impact of TAVR on coronary arteries and hemodynamic changes to the circulatory system resulting from post-TAVR anatomical changes remain incompletely understood.
Does TAVR affect coronary and cardiac hemodynamics in patient-specific computational models?
Does TAVR affect coronary and cardiac hemodynamics in patient-specific computational models?
Patient-specific computational modeling suggests TAVR may adversely impact coronary hemodynamics by reducing diastolic coronary blood flow and increasing left ventricular workload.
May signal microvascular impairment warranting caution; hypothesis-generating and requires prospective validation before practice change.
Background Despite the proven benefits of transcatheter aortic valve replacement (TAVR) and its recent expansion toward the whole risk spectrum, coronary artery disease is present in more than half of the candidates for TAVR. Many previous studies do not focus on the longer-term impact of TAVR on coronary arteries, and hemodynamic changes to the circulatory system in response to the anatomical changes caused by TAVR are not fully understood. Methods and Results We developed a multiscale patient-specific computational framework to examine the effect of TAVR on coronary and cardiac hemodynamics noninvasively. Based on our findings, TAVR might have an adverse impact on coronary hemodynamics due to the lack of sufficient coronary blood flow during diastole phase (eg, maximum coronary flow rate reduced by 8.98%, 16.83%, and 22.73% in the left anterior descending, left circumflex coronary artery, and right coronary artery, respectively [N=31]). Moreover, TAVR may increase the left ventricle workload (eg, left ventricle workload increased by 2.52% [N=31]) and decrease the coronary wall shear stress (eg, maximum time averaged wall shear stress reduced by 9.47%, 7.75%, 6.94%, 8.07%, and 6.28% for bifurcation, left main coronary artery, left anterior descending, left circumflex coronary artery, and right coronary artery branches, respectively). Conclusions The transvalvular pressure gradient relief after TAVR might not result in coronary flow improvement and reduced cardiac load. Optimal revascularization strategy pre-TAVR and progression of coronary artery disease after TAVR could be determined by noninvasive personalized computational modeling.
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Khodaei et al. (2023) studied TAVR candidates (n=31). Transcatheter aortic valve replacement (TAVR) vs. Pre-TAVR baseline was evaluated on Coronary and cardiac hemodynamics (coronary flow rate, left ventricle workload, coronary wall shear stress). In a computational model of 31 patients, TAVR adversely impacted coronary hemodynamics, reducing maximum coronary flow rate by up to 22.73% and increasing left ventricle workload by 2.52%.
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