Comparison of performance of self-expanding and balloon-expandable transcatheter aortic valvesCentral MessagePerspective
Hoda Hatoum, PhD,
Milad Samaee, PhD,
Janarthanan Sathananthan, MBChB, MPH,
Stephanie Sellers, MSc, PhD,
Maximilian Kuetting, PhD,
Scott M. Lilly, MD, PhD,
Abdul R. Ihdayhid, MBBS, PhD,
Philipp Blanke, MD,
Jonathon Leipsic, MD,
Vinod H. Thourani, MD,
Lakshmi Prasad Dasi, PhD
Affiliations
Hoda Hatoum, PhD
Department of Biomedical Engineering, Michigan Technological University, Houghton, Mich; Health Research Institute, Center of Biocomputing and Digital Health and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Mich; Address for reprints: Hoda Hatoum, PhD, Department of Biomedical Engineering, Michigan Technological University, 1400 Townsend Dr, Houghton, MI 49931.
Milad Samaee, PhD
Biomedical Engineering Department, Georgia Institute of Technology, Atlanta, Ga
Janarthanan Sathananthan, MBChB, MPH
Center for Cardiovascular Innovation, Cardiovascular Translational Laboratory, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada; Janarthanan Sathananthan, MBChB, MPH, Centre for Cardiovascular Innovation, Centre for Heart Valve Innovation, Cardiovascular Translational Laboratory, St Paul's and Vancouver General Hospital, 2775 Laurel St, Vancouver, British Columbia, Canada V5Z 1M9
Stephanie Sellers, MSc, PhD
Center for Cardiovascular Innovation, Cardiovascular Translational Laboratory, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
Maximilian Kuetting, PhD
New Valve Technology, Hechingen, Germany
Scott M. Lilly, MD, PhD
Division of Cardiovascular Medicine, The Ohio State University Wexner Medical Center, Columbus, Ohio
Abdul R. Ihdayhid, MBBS, PhD
Fiona Stanley Hospital, Harry Perkins Institute of Medical Research, Perth, Western Australia, Australia
Philipp Blanke, MD
Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
Jonathon Leipsic, MD
Department of Radiology, St Paul's Hospital, University of British Columbia, Vancouver, British Columbia, Canada
Vinod H. Thourani, MD
Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Ga
Lakshmi Prasad Dasi, PhD
Biomedical Engineering Department, Georgia Institute of Technology, Atlanta, Ga; Lakshmi Prasad Dasi, PhD, Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA 30313
Objective: To evaluate the flow dynamics of self-expanding and balloon-expandable transcatheter aortic valves pertaining to turbulence and pressure recovery. Transcatheter aortic valves are characterized by different designs that have different valve performance and outcomes. Methods: Assessment of transcatheter aortic valves was performed using self-expanding devices (26-mm Evolut [Medtronic], 23-mm Allegra [New Valve Technologies], and small Acurate neo [Boston Scientific]) and a balloon-expandable device (23-mm Sapien 3 [Edwards Lifesciences]). Particle image velocimetry assessed the flow downstream. A Millar catheter was used for pressure recovery calculation. Velocity, Reynolds shear stresses, viscous shear stress, and pressure gradients were calculated. Results: The maximal velocity at peak systole obtained with the Evolut R, Sapien 3, Acurate neo, and Allegra was 2.12 ± 0.19 m/sec, 2.41 ± 0.06 m/sec, 2.99 ± 0.10 m/sec, and 2.45 ± 0.08 m/sec, respectively (P < .001). Leaflet oscillations with the flow were clear with the Evolut R and Acurate neo. The Allegra shows the minimal range of Reynolds shear stress magnitudes (up to 320 Pa), and Sapien 3 the maximal (up to 650 Pa). The Evolut had the smallest viscous shear stress magnitude range (up to 3.5 Pa), and the Sapien 3 the largest (up to 6.2 Pa). The largest pressure drop at the vena contracta occurred with the Acurate neo transcatheter aortic valve with a pressure gradient of 13.96 ± 1.35 mm Hg. In the recovery zone, the smallest pressure gradient was obtained with the Allegra (3.32 ± 0.94 mm Hg). Conclusions: Flow dynamics downstream of different transcatheter aortic valves vary significantly depending on the valve type, despite not having a general trend depending on whether or not valves are self-expanding or balloon-expandable. Deployment design did not have an influence on flow dynamics.
