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Mixed Valvular Disease Following Transcatheter Aortic Valve Replacement: Quantification and Systematic Differentiation Using Clinical Measurements and Image-Based Patient‐Specific In Silico Modeling

Keshavarz‐Motamed, Zahra and Khodaei, Seyedvahid and Rikhtegar Nezami, Farhad and Amrute, Junedh M. and Lee, Suk Joon and Brown, Jonathan and Ben‐Assa, Eyal and Garcia Camarero, Tamara and Ruano Calvo, Javier and Sellers, Stephanie and Blanke, Philipp and Leipsic, Jonathon and de la Torre Hernandez, Jose M. and Edelman, Elazer R. (2020) Mixed Valvular Disease Following Transcatheter Aortic Valve Replacement: Quantification and Systematic Differentiation Using Clinical Measurements and Image-Based Patient‐Specific In Silico Modeling. Journal of the American Heart Association, 9 (5). Art. No. e015063. ISSN 2047-9980. https://resolver.caltech.edu/CaltechAUTHORS:20200303-111409576

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Abstract

Background: Mixed valvular disease (MVD), mitral regurgitation (MR) from pre‐existing disease in conjunction with paravalvular leak (PVL) following transcatheter aortic valve replacement (TAVR), is one of the most important stimuli for left ventricle (LV) dysfunction, associated with cardiac mortality. Despite the prevalence of MVD, the quantitative understanding of the interplay between pre‐existing MVD, PVL, LV, and post‐TAVR recovery is meager. Methods and Results: We quantified the effects of MVD on valvular‐ventricular hemodynamics using an image‐based patient‐specific computational framework in 72 MVD patients. Doppler pressure was reduced by TAVR (mean, 77%; N=72; P<0.05), but it was not always accompanied by improvements in LV workload. TAVR had no effect on LV workload in 22 patients, and LV workload post‐TAVR significantly rose in 32 other patients. TAVR reduced LV workload in only 18 patients (25%). PVL significantly alters LV flow and increases shear stress on transcatheter aortic valve leaflets. It interacts with mitral inflow and elevates shear stresses on mitral valve and is one of the main contributors in worsening of MR post‐TAVR. MR worsened in 32 patients post‐TAVR and did not improve in 18 other patients. Conclusions: PVL limits the benefit of TAVR by increasing LV load and worsening of MR and heart failure. Post‐TAVR, most MVD patients (75% of N=72; P<0.05) showed no improvements or even worsening of LV workload, whereas the majority of patients with PVL, but without that pre‐existing MR condition (60% of N=48; P<0.05), showed improvements in LV workload. MR and its exacerbation by PVL may hinder the success of TAVR.


Item Type:Article
Related URLs:
URLURL TypeDescription
https://doi.org/10.1161/jaha.119.015063DOIArticle
https://www.ahajournals.org/doi/suppl/10.1161/JAHA.119.015063PublisherSupplementary Data
ORCID:
AuthorORCID
Rikhtegar Nezami, Farhad0000-0002-4210-3177
Additional Information:© 2020 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley Blackwell. This is an open access article under the terms of the Creative Commons Attribution‐NonCommercial‐NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. Manuscript received October 23, 2019; Manuscript accepted January 9, 2020; Originally published February 28, 2020. Keshavarz‐Motamed and Khodaei were supported, in part, by Natural Sciences and Engineering Research Council (NSERC) Discovery Grant (RGPIN‐2017‐05349). Edelman was supported, in part, by a grant from the National Institutes of Health (GM R01 49039). Disclosures: Keshavarz‐Motamed has research grants from NSERC, but there is no overlap with the work in this study. Edelman has research grants from Edwards LifeSciences, Boston Scientific, and Medtronic, but there is no overlap with the work in this study. The remaining authors have no disclosures to report.
Funders:
Funding AgencyGrant Number
Natural Sciences and Engineering Research Council of Canada (NSERC)RGPIN‐2017‐05349
NIHGM R01 49039
Subject Keywords:left ventricle hemodynamics; mitral regurgitation; mixed valvular disease; paravalvular leak; transcatheter aortic valve replacement
Issue or Number:5
Record Number:CaltechAUTHORS:20200303-111409576
Persistent URL:https://resolver.caltech.edu/CaltechAUTHORS:20200303-111409576
Official Citation:Mixed Valvular Disease Following Transcatheter Aortic Valve Replacement: Quantification and Systematic Differentiation Using Clinical Measurements and Image‐Based Patient‐Specific In Silico Modeling. J Am Heart Assoc. 2020;9:e015063. DOI: 10.1161/JAHA.119.015063.
Usage Policy:No commercial reproduction, distribution, display or performance rights in this work are provided.
ID Code:101681
Collection:CaltechAUTHORS
Deposited By: Tony Diaz
Deposited On:03 Mar 2020 20:34
Last Modified:03 Mar 2020 20:34

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