Native Sinus Hemodynamics and Thrombosis in Transcatheter Heart Valve: Effect of Implant Depth and Coronary Flow
Background This study aimed to investigate the hemodynamic and anatomic factors associated with sinus thrombosis following transcatheter aortic valve replacement (TAVR), integrating in vivo patient data analysis and in vitro experiments. Methods and Results Postprocedural, 4‐dimensional, multiphase...
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Wiley
2024-11-01
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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.124.037105 |
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| author | Hyun Jung Koo Jihun Kang Do‐Yoon Kang Jung‐Min Ahn Duk‐Woo Park Seung‐Jung Park Joon‐Won Kang Hojin Ha Dong Hyun Yang |
| author_facet | Hyun Jung Koo Jihun Kang Do‐Yoon Kang Jung‐Min Ahn Duk‐Woo Park Seung‐Jung Park Joon‐Won Kang Hojin Ha Dong Hyun Yang |
| author_sort | Hyun Jung Koo |
| collection | DOAJ |
| description | Background This study aimed to investigate the hemodynamic and anatomic factors associated with sinus thrombosis following transcatheter aortic valve replacement (TAVR), integrating in vivo patient data analysis and in vitro experiments. Methods and Results Postprocedural, 4‐dimensional, multiphase computed tomography data from 211 patients enrolled in the ADAPT‐TAVR (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement) study were analyzed. The prevalence of native sinus thrombosis was examined in relation to valve type, implant depth, and anatomic features. In vitro experiments used particle image velocimetry to observe changes in sinus flow based on the transcatheter heart valves (23‐mm SAPIEN3, Edwards Lifesciences; and 29‐mm CoreValve, Medtronic) height and coronary artery flow. Native sinus thrombosis was more common in self‐expanding valves (39.1% versus 14.9%, P=0.004). In per‐cusp analysis of in vivo patient data, adjusted transcatheter heart valve implant depth (odds ratio, 1.2 [95% CI, 1.1–1.3]; P<0.001), noncoronary sinus of Valsalva (odds ratio, 4.0 [95% CI, 2.0–7.8]; P<0.001), sinus inflow diameter (odds ratio, 0.8 [95% CI, 0.6–0.9]; P=0.008), and implanted valve size (odds ratio, 0.8 [95% CI, 0.7–1.0]; P=0.025) were significant factors associated with native sinus thrombosis. In the in vitro experiments, CoreValve showed noticeable flow stasis compared with SAPIEN3. High‐positioned SAPIEN3 was linked to reduced velocity within the native sinus of Valsalva. Coronary artery flow led to higher sinus velocity and improved particle washout, reducing sinus thrombosis risk. Conclusions This study provides insights into the relationship between transcatheter heart valve deployment and native sinus thrombosis, emphasizing the role of anatomic factors in relation to the risk of sinus thrombosis. |
| format | Article |
| id | doaj-art-b9c63ed91ee648e0aa9ce472ebbca961 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-b9c63ed91ee648e0aa9ce472ebbca9612025-08-20T02:07:28ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-11-01132110.1161/JAHA.124.037105Native Sinus Hemodynamics and Thrombosis in Transcatheter Heart Valve: Effect of Implant Depth and Coronary FlowHyun Jung Koo0Jihun Kang1Do‐Yoon Kang2Jung‐Min Ahn3Duk‐Woo Park4Seung‐Jung Park5Joon‐Won Kang6Hojin Ha7Dong Hyun Yang8Department of Radiology and Research Institute of Radiology, Cardiac Imaging Center University of Ulsan College of Medicine, Asan Medical Center Seoul South KoreaInterdisciplinary Program in Biohealth‐Machinery Convergence Engineering Kangwon National University Chuncheon South KoreaDivision of Cardiology University of Ulsan College of Medicine, Asan Medical Center Seoul South KoreaDivision of Cardiology University of Ulsan College of Medicine, Asan Medical Center Seoul South KoreaDivision of Cardiology University of Ulsan College of Medicine, Asan Medical Center Seoul South KoreaDivision of Cardiology University of Ulsan College of Medicine, Asan Medical Center Seoul South KoreaDepartment of Radiology and Research Institute of Radiology, Cardiac Imaging Center University of Ulsan College of Medicine, Asan Medical Center Seoul South KoreaInterdisciplinary Program in Biohealth‐Machinery Convergence Engineering Kangwon National University Chuncheon South KoreaDepartment of Radiology and Research Institute of Radiology, Cardiac Imaging Center University of Ulsan College of Medicine, Asan Medical Center Seoul South KoreaBackground This study aimed to investigate the hemodynamic and anatomic factors associated with sinus thrombosis following transcatheter aortic valve replacement (TAVR), integrating in vivo patient data analysis and in vitro experiments. Methods and Results Postprocedural, 4‐dimensional, multiphase computed tomography data from 211 patients enrolled in the ADAPT‐TAVR (Anticoagulation Versus Dual Antiplatelet Therapy for Prevention of Leaflet Thrombosis and Cerebral Embolization After Transcatheter Aortic Valve Replacement) study were analyzed. The prevalence of native sinus thrombosis was examined in relation to valve type, implant depth, and anatomic features. In vitro experiments used particle image velocimetry to observe changes in sinus flow based on the transcatheter heart valves (23‐mm SAPIEN3, Edwards Lifesciences; and 29‐mm CoreValve, Medtronic) height and coronary artery flow. Native sinus thrombosis was more common in self‐expanding valves (39.1% versus 14.9%, P=0.004). In per‐cusp analysis of in vivo patient data, adjusted transcatheter heart valve implant depth (odds ratio, 1.2 [95% CI, 1.1–1.3]; P<0.001), noncoronary sinus of Valsalva (odds ratio, 4.0 [95% CI, 2.0–7.8]; P<0.001), sinus inflow diameter (odds ratio, 0.8 [95% CI, 0.6–0.9]; P=0.008), and implanted valve size (odds ratio, 0.8 [95% CI, 0.7–1.0]; P=0.025) were significant factors associated with native sinus thrombosis. In the in vitro experiments, CoreValve showed noticeable flow stasis compared with SAPIEN3. High‐positioned SAPIEN3 was linked to reduced velocity within the native sinus of Valsalva. Coronary artery flow led to higher sinus velocity and improved particle washout, reducing sinus thrombosis risk. Conclusions This study provides insights into the relationship between transcatheter heart valve deployment and native sinus thrombosis, emphasizing the role of anatomic factors in relation to the risk of sinus thrombosis.https://www.ahajournals.org/doi/10.1161/JAHA.124.037105aortic stenosiscomputed tomographythrombosistranscatheter aortic valve replacement |
| spellingShingle | Hyun Jung Koo Jihun Kang Do‐Yoon Kang Jung‐Min Ahn Duk‐Woo Park Seung‐Jung Park Joon‐Won Kang Hojin Ha Dong Hyun Yang Native Sinus Hemodynamics and Thrombosis in Transcatheter Heart Valve: Effect of Implant Depth and Coronary Flow Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease aortic stenosis computed tomography thrombosis transcatheter aortic valve replacement |
| title | Native Sinus Hemodynamics and Thrombosis in Transcatheter Heart Valve: Effect of Implant Depth and Coronary Flow |
| title_full | Native Sinus Hemodynamics and Thrombosis in Transcatheter Heart Valve: Effect of Implant Depth and Coronary Flow |
| title_fullStr | Native Sinus Hemodynamics and Thrombosis in Transcatheter Heart Valve: Effect of Implant Depth and Coronary Flow |
| title_full_unstemmed | Native Sinus Hemodynamics and Thrombosis in Transcatheter Heart Valve: Effect of Implant Depth and Coronary Flow |
| title_short | Native Sinus Hemodynamics and Thrombosis in Transcatheter Heart Valve: Effect of Implant Depth and Coronary Flow |
| title_sort | native sinus hemodynamics and thrombosis in transcatheter heart valve effect of implant depth and coronary flow |
| topic | aortic stenosis computed tomography thrombosis transcatheter aortic valve replacement |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.124.037105 |
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