Key result
Bench tests and numerical simulations of the CoreValve delivery system demonstrated pushing forces up to 14.4 N during catheter bending and vascular wall stress up to 0.8 MPa.
Why the study?
The mechanism of vascular complications due to catheter-vascular wall interaction in transcatheter aortic valve replacement was not well understood.
Bench tests and numerical simulations demonstrate that the TAVR delivery system exerts significant forces and stress on the aortic wall, particularly during bending in the aortic arch, which may explain vascular injury mechanisms.
May inform TAVR delivery system redesign to limit aortic wall stress; bench data leave open clinical injury correlation.
was to determine the potential mechanism of vascular complications due to "catheter-vascular wall" interaction in transcatheter aortic valve replacement using experimental and numerical analysis. MATERIALS AND METHODS: A series of full-scale bench tests and numerical simulations were carried out using the CoreValve commercial transfemoral delivery system for aortic valve bioprosthesis (Medtronic Inc., USA). Full-scale tests were carried out using a phantom of the vascular system (a polymeric silicone model of Transcatheter Aortic Valve; Trandomed 3D Inc., China) with simulation of all stages of delivery system movement along the vascular bed. They involved introduction into the common femoral artery, movement along the abdominal and thoracic parts of the aorta, the aortic arch, and positioning the system to the implantation site. The force arising from the passage of the delivery system was assessed using sensors of a Z50 universal testing machine (Zwick/Roell, Germany). Numerical simulation of transcatheter valve replacement procedure was carried out in a similar way with allowance for the patient-specific anatomy of the recipient's aorta using the finite element method in the Abaqus/CAE environment (Dassault Systèmes, France). RESULTS: It was found that in the process of the delivery system passing through the vascular system, there occurred force fluctuations associated with catheter bending and its interaction with the aortic wall in the region of its arch. For example, in the initial straight portions, the pushing force was 3.8-7.9 N; the force increased to the maximum (11.1 and 14.4 N with and without the prosthesis) with bending of the distal portion of the catheter. A similar increase was observed when performing numerical simulation with high-quality graphic visualization of stress on the "spots" of contact between the catheter and the vascular wall with an increase in stress to 0.8 MPa. CONCLUSION: Numerical and full-scale bench tests prove the significant effect of the properties of delivery system catheter for transcatheter aortic valve replacement on the interaction with the aortic walls.
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Овчаренко et al. (2021) studied Vascular complications in transcatheter aortic valve replacement. CoreValve commercial transfemoral delivery system was evaluated on Force arising from the passage of the delivery system and stress on the vascular wall. Bench tests and numerical simulations of the CoreValve delivery system demonstrated pushing forces up to 14.4 N during catheter bending and vascular wall stress up to 0.8 MPa.
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