Why the study?
Cardiac conduction abnormality is a major persistent complication after TAVR, and localized stresses exerted on the membranous septum by the device frame may disturb cardiac conduction.
Can computational modeling of mechanical stress (AMPLS) in the membranous septum predict the risk of cardiac conduction abnormality following TAVR?
Observational (n=2)
Can computational modeling of mechanical stress (AMPLS) in the membranous septum predict the risk of cardiac conduction abnormality following TAVR?
Patient-specific computational modeling demonstrates that elevated mechanical stress in the membranous septum during TAVR deployment correlates with the risk of post-procedural conduction abnormalities requiring a pacemaker.
BACKGROUND: Cardiac conduction abnormality (CCA)- one of the major persistent complications associated with transcatheter aortic valve replacement (TAVR) may lead to permanent pacemaker implantation. Localized stresses exerted by the device frame on the membranous septum (MS) which lies between the aortic annulus and the bundle of His, may disturb the cardiac conduction and cause the resultant CCA. We hypothesize that the area-weighted average maximum principal logarithmic strain (AMPLS) in the MS region can predict the risk of CCA following TAVR. METHODS: Rigorous finite element-based analysis was conducted in two patients (Balloon expandable TAVR recipients) to assess post-TAVR CCA risk. Following the procedure one of the patients required permanent pacemaker (PPM) implantation while the other did not (control case). Patient-specific aortic root was modeled, MS was identified from the CT image, and the TAVR deployment was simulated. Mechanical factors in the MS region such as logarithmic strain, contact force, contact pressure, contact pressure index (CPI) and their time history during the TAVR deployment; and anatomical factors such as MS length, implantation depth, were analyzed. RESULTS: Maximum AMPLS (0.47 and 0.37, respectively), contact force (0.92 N and 0.72 N, respectively), and CPI (3.99 and 2.86, respectively) in the MS region were significantly elevated in the PPM patient as compared to control patient. CONCLUSION: Elevated stresses generated by TAVR devices during deployment appear to correlate with CCA risk, with AMPLS in the MS region emerging as a strong predictor that could be used for preprocedural planning in order to minimize CCA risk.
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Reza et al. (2022) conducted an observational in Post-TAVR cardiac conduction abnormality (n=2). Elevated mechanical stresses during TAVR deployment vs. Control patient (no permanent pacemaker) was evaluated on Maximum area-weighted average maximum principal logarithmic strain (AMPLS), contact force, and contact pressure index in the membranous septum region.
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