Affiliation:
1. Department of Mechanical Engineering McMaster University Hamilton Ontario Canada
2. School of Biomedical Engineering McMaster University Hamilton Ontario Canada
3. Department of Systems Design Engineering University of Waterloo Ontario Canada
4. Centre for Bioengineering and Biotechnology University of Waterloo Ontario Canada
5. Department of Electrical and Computer Engineering McMaster University Hamilton Ontario Canada
6. School of Computational Science and Engineering McMaster University Hamilton Ontario Canada
Abstract
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.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Cardiology and Cardiovascular Medicine
Cited by
5 articles.
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