Reducing Long‐Term Mortality Post Transcatheter Aortic Valve Replacement Requires Systemic Differentiation of Patient‐Specific Coronary Hemodynamics
Background Despite the proven benefits of transcatheter aortic valve replacement (TAVR) and its recent expansion toward the whole risk spectrum, coronary artery disease is present in more than half of the candidates for TAVR. Many previous studies do not focus on the longer‐term impact of TAVR on co...
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Wiley
2023-06-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.029310 |
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| author | Seyedvahid Khodaei Louis Garber Mohamed Abdelkhalek Nima Maftoon Ali Emadi Zahra Keshavarz‐Motamed |
| author_facet | Seyedvahid Khodaei Louis Garber Mohamed Abdelkhalek Nima Maftoon Ali Emadi Zahra Keshavarz‐Motamed |
| author_sort | Seyedvahid Khodaei |
| collection | DOAJ |
| description | Background Despite the proven benefits of transcatheter aortic valve replacement (TAVR) and its recent expansion toward the whole risk spectrum, coronary artery disease is present in more than half of the candidates for TAVR. Many previous studies do not focus on the longer‐term impact of TAVR on coronary arteries, and hemodynamic changes to the circulatory system in response to the anatomical changes caused by TAVR are not fully understood. Methods and Results We developed a multiscale patient‐specific computational framework to examine the effect of TAVR on coronary and cardiac hemodynamics noninvasively. Based on our findings, TAVR might have an adverse impact on coronary hemodynamics due to the lack of sufficient coronary blood flow during diastole phase (eg, maximum coronary flow rate reduced by 8.98%, 16.83%, and 22.73% in the left anterior descending, left circumflex coronary artery, and right coronary artery, respectively [N=31]). Moreover, TAVR may increase the left ventricle workload (eg, left ventricle workload increased by 2.52% [N=31]) and decrease the coronary wall shear stress (eg, maximum time averaged wall shear stress reduced by 9.47%, 7.75%, 6.94%, 8.07%, and 6.28% for bifurcation, left main coronary artery, left anterior descending, left circumflex coronary artery, and right coronary artery branches, respectively). Conclusions The transvalvular pressure gradient relief after TAVR might not result in coronary flow improvement and reduced cardiac load. Optimal revascularization strategy pre‐TAVR and progression of coronary artery disease after TAVR could be determined by noninvasive personalized computational modeling. |
| format | Article |
| id | doaj-art-283dc00ac38f4be0aa812fa1234eb255 |
| institution | DOAJ |
| issn | 2047-9980 |
| language | English |
| publishDate | 2023-06-01 |
| publisher | Wiley |
| record_format | Article |
| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-283dc00ac38f4be0aa812fa1234eb2552025-08-20T02:59:11ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802023-06-01121110.1161/JAHA.123.029310Reducing Long‐Term Mortality Post Transcatheter Aortic Valve Replacement Requires Systemic Differentiation of Patient‐Specific Coronary HemodynamicsSeyedvahid Khodaei0Louis Garber1Mohamed Abdelkhalek2Nima Maftoon3Ali Emadi4Zahra Keshavarz‐Motamed5Department of Mechanical Engineering McMaster University Hamilton Ontario CanadaSchool of Biomedical Engineering McMaster University Hamilton Ontario CanadaSchool of Biomedical Engineering McMaster University Hamilton Ontario CanadaDepartment of Systems Design Engineering University of Waterloo Ontario CanadaDepartment of Mechanical Engineering McMaster University Hamilton Ontario CanadaDepartment of Mechanical Engineering McMaster University Hamilton Ontario CanadaBackground Despite the proven benefits of transcatheter aortic valve replacement (TAVR) and its recent expansion toward the whole risk spectrum, coronary artery disease is present in more than half of the candidates for TAVR. Many previous studies do not focus on the longer‐term impact of TAVR on coronary arteries, and hemodynamic changes to the circulatory system in response to the anatomical changes caused by TAVR are not fully understood. Methods and Results We developed a multiscale patient‐specific computational framework to examine the effect of TAVR on coronary and cardiac hemodynamics noninvasively. Based on our findings, TAVR might have an adverse impact on coronary hemodynamics due to the lack of sufficient coronary blood flow during diastole phase (eg, maximum coronary flow rate reduced by 8.98%, 16.83%, and 22.73% in the left anterior descending, left circumflex coronary artery, and right coronary artery, respectively [N=31]). Moreover, TAVR may increase the left ventricle workload (eg, left ventricle workload increased by 2.52% [N=31]) and decrease the coronary wall shear stress (eg, maximum time averaged wall shear stress reduced by 9.47%, 7.75%, 6.94%, 8.07%, and 6.28% for bifurcation, left main coronary artery, left anterior descending, left circumflex coronary artery, and right coronary artery branches, respectively). Conclusions The transvalvular pressure gradient relief after TAVR might not result in coronary flow improvement and reduced cardiac load. Optimal revascularization strategy pre‐TAVR and progression of coronary artery disease after TAVR could be determined by noninvasive personalized computational modeling.https://www.ahajournals.org/doi/10.1161/JAHA.123.029310cardiac fluid dynamicscoronary hemodynamicsglobal hemodynamicslocal fluid dynamicspatient‐specific lumped parameter modeltranscatheter aortic valve replacement |
| spellingShingle | Seyedvahid Khodaei Louis Garber Mohamed Abdelkhalek Nima Maftoon Ali Emadi Zahra Keshavarz‐Motamed Reducing Long‐Term Mortality Post Transcatheter Aortic Valve Replacement Requires Systemic Differentiation of Patient‐Specific Coronary Hemodynamics Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease cardiac fluid dynamics coronary hemodynamics global hemodynamics local fluid dynamics patient‐specific lumped parameter model transcatheter aortic valve replacement |
| title | Reducing Long‐Term Mortality Post Transcatheter Aortic Valve Replacement Requires Systemic Differentiation of Patient‐Specific Coronary Hemodynamics |
| title_full | Reducing Long‐Term Mortality Post Transcatheter Aortic Valve Replacement Requires Systemic Differentiation of Patient‐Specific Coronary Hemodynamics |
| title_fullStr | Reducing Long‐Term Mortality Post Transcatheter Aortic Valve Replacement Requires Systemic Differentiation of Patient‐Specific Coronary Hemodynamics |
| title_full_unstemmed | Reducing Long‐Term Mortality Post Transcatheter Aortic Valve Replacement Requires Systemic Differentiation of Patient‐Specific Coronary Hemodynamics |
| title_short | Reducing Long‐Term Mortality Post Transcatheter Aortic Valve Replacement Requires Systemic Differentiation of Patient‐Specific Coronary Hemodynamics |
| title_sort | reducing long term mortality post transcatheter aortic valve replacement requires systemic differentiation of patient specific coronary hemodynamics |
| topic | cardiac fluid dynamics coronary hemodynamics global hemodynamics local fluid dynamics patient‐specific lumped parameter model transcatheter aortic valve replacement |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.029310 |
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