Key result
Reduced cardiac output (2.0 L/min vs 5.0 L/min) increased the area of high blood residence time on transcatheter aortic valve leaflets from 2% to 11%, indicating a ~sixfold increase in blood stasis.
Why the study?
Does reduced cardiac output increase blood stasis on transcatheter aortic valve leaflets in a computational model?
Does reduced cardiac output increase blood stasis on transcatheter aortic valve leaflets in a computational model?
Reduced cardiac output is associated with increased blood stasis on TAV leaflets in computational models, suggesting it may be a permissive factor for valve thrombosis.
Low cardiac output may heighten TAV thrombosis risk via stasis; leaves open clinical relevance pending prospective validation.
AIMS: There is an increasing awareness of leaflet thrombosis following transcatheter aortic valve implantation (TAVI) and valve-in-valve (ViV) procedures. Nevertheless, the predisposing factors affecting transcatheter aortic valve (TAV) thrombosis have remained unclear. This study aimed to quantify the effects of reduced cardiac output (CO) on blood stasis on the TAV leaflets as a permissive factor for valve thrombosis. METHODS AND RESULTS: An idealised computational model representing a TAV was developed in a patient-specific geometry. Three-dimensional flow fields were obtained via a fluid-solid interaction modelling approach at different COs: 5.0, 3.5, 2.0 L/min. Blood residence time (BRT) was subsequently calculated on the leaflets. An association between reduced CO and increased blood stasis on the TAV leaflets was observed. At the end of diastole, larger areas of high BRT (>1.2 s) were observed at the leaflet's fixed edge at low COs. Such areas were calculated to be 2, 8, and 11% of the total surface area of leaflets at CO=5.0, 3.5, and 2.0 L/min, respectively, indicating a ~sixfold increase of BRT on the leaflets from the highest to the lowest CO. CONCLUSIONS: This study indicates an association between reduced CO and increased blood stasis on the TAV leaflets which can be regarded as a precursor of valve thrombosis.
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Vahidkhah et al. (2017) studied Transcatheter aortic valve thrombosis. Reduced cardiac output vs. Normal cardiac output (5.0 L/min) was evaluated on Area of high blood residence time (>1.2 s) on the leaflets at the end of diastole (~sixfold increase). Reduced cardiac output (2.0 L/min vs 5.0 L/min) increased the area of high blood residence time on transcatheter aortic valve leaflets from 2% to 11%, indicating a ~sixfold increase in blood stasis.
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