Key result
Virtual replacement with biological prostheses induced significantly higher wall shear stress (9.3 vs. 8.6 Pa, P=0.027) and transvalvular pressure drop than mechanical prostheses in CFD simulations.
Why the study?
Does virtual valve replacement with a biological prosthesis compared to a mechanical prosthesis alter aortic hemodynamics in patient-specific MRI-based CFD simulations?
Does virtual valve replacement with a biological prosthesis compared to a mechanical prosthesis alter aortic hemodynamics in patient-specific MRI-based CFD simulations?
Absolute Event Rate: 9.3% vs 8.6%
p-value: p=0.027
Patient-specific MRI-based CFD simulations demonstrate that biological aortic valve prostheses induce significantly higher wall shear stress, transvalvular pressure drop, and turbulent kinetic energy compared to mechanical prostheses, with high inter-patient variability.
Simulations link biological prostheses to higher shear stress; hypothesis-generating for clinical valve selection and outcomes.
Modeling different treatment options before a procedure is performed is a promising approach for surgical decision making and patient care in heart valve disease. This study investigated the hemodynamic impact of different prostheses through patient‐specific MRI‐based CFD simulations. Ten time‐resolved MRI data sets with and without velocity encoding were obtained to reconstruct the aorta and set hemodynamic boundary conditions for simulations. Aortic hemodynamics after virtual valve replacement with a biological and mechanical valve prosthesis were investigated. Wall shear stress (WSS), secondary flow degree (SFD), transvalvular pressure drop (TPD), turbulent kinetic energy (TKE), and normalized flow displacement (NFD) were evaluated to characterize valve‐induced hemodynamics. The biological prostheses induced significantly higher WSS (medians: 9.3 vs. 8.6 Pa, P = 0.027) and SFD (means: 0.78 vs. 0.49, P = 0.002) in the ascending aorta, TPD (medians: 11.4 vs. 2.7 mm Hg, P = 0.002), TKE (means: 400 vs. 283 cm 2 /s 2 , P = 0.037), and NFD (means: 0.0994 vs. 0.0607, P = 0.020) than the mechanical prostheses. The differences between the prosthesis types showed great inter‐patient variability, however. Given this variability, a patient‐specific evaluation is warranted. In conclusion, MRI‐based CFD offers an opportunity to assess the interactions between prosthesis and patient‐specific boundary conditions, which may help in optimizing surgical decision making and providing additional guidance to clinicians.
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Hellmeier et al. (2017) studied Heart valve disease (n=10). Virtual biological aortic valve prosthesis vs. Virtual mechanical aortic valve prosthesis was evaluated on Wall shear stress (WSS) in the ascending aorta (Pa) (p=0.027). Virtual replacement with biological prostheses induced significantly higher wall shear stress (9.3 vs. 8.6 Pa, P=0.027) and transvalvular pressure drop than mechanical prostheses in CFD simulations.
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