Fluid dynamics and blood damage in the dilated ascending aorta after mechanical prosthetic valve implantation: an in vitro study

The implantation of aortic valve prostheses is often associated with the dilation of the ascending aorta. It is well known that the modification of the fluid dynamics induced by both the prosthetic valve and aortic dilation may, in turn, promote further vessel remodelling. Besides, when the prosthesis is mechanical, a major concern is the blood cell damage and platelet activation which requires a lifelong anticoagulant therapy, which in turn is an additional significant factor of comorbidity. We analysed in vitro the combined effect of the presence of a bileaflet mechanical aortic valve and the dilation of the aortic root in patient specific laboratory models. Three model aortas with increasing degree of dilation, hosted in a mock loop reproducing the heart flow pulsatility, were investigated. The measurement of the time-resolved velocity field allowed the analysis of the general structure of the flow and shear strain-rate distribution. Additionally, the Blood Damage Indexes (BDIs) for both haemolysis and platelet activation were computed along synthetic particle trajectories. Results suggest that a feedback process can be triggered since the aortic dilation tends to decrease the shear stresses at the walls and favour blood stasis: two factors that are known to promote vessel remodelling. Secondly, the analysis of BDIs shows that aortic dilation significantly increases the damage index for haemolysis, whereas a similar effect is not shown when focusing on platelet activation.