Affordable Access

deepdyve-link
Publisher Website

Can bioprosthetic valve thrombosis be promoted by aortic root morphology? An in vitro study.

Authors
  • Jahren, Silje Ekroll1
  • Heinisch, Paul Philipp2
  • Hasler, David1
  • Winkler, Bernhard Michael2
  • Stortecky, Stefan3
  • Pilgrim, Thomas3
  • Londono, Martina Correa4
  • Carrel, Thierry2
  • von Tengg-Kobligk, Hendrik4
  • Obrist, Dominik1
  • 1 ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland. , (Switzerland)
  • 2 Department of Cardiovascular Surgery, University Hospital Bern, University of Bern, Bern, Switzerland. , (Switzerland)
  • 3 Department of Cardiology, University Hospital Bern, University of Bern, Bern, Switzerland. , (Switzerland)
  • 4 University Institute of Diagnostic, Interventional and Paediatric Radiology, University Hospital Bern, University of Bern, Bern, Switzerland. , (Switzerland)
Type
Published Article
Journal
Interactive Cardiovascular and Thoracic Surgery
Publisher
Oxford University Press
Publication Date
Jul 01, 2018
Volume
27
Issue
1
Pages
108–115
Identifiers
DOI: 10.1093/icvts/ivy039
PMID: 29481667
Source
Medline
Language
English
License
Unknown

Abstract

Bioprosthetic valve thrombosis has been considered uncommon, but recent studies have shown that it is more frequent than previously thought. Insufficient washout of the aortic sinus is believed to be a risk factor for bioprosthetic valve thrombosis. The objective of this in vitro experiment was to investigate the impact of aortic root morphology on blood flow in the aortic sinus and to relate these results to in vivo data obtained in patients with a transcatheter aortic valve implant. Two compliant aortic root phantoms with different morphologies (symmetrical and patient-specific) were fabricated with silicone. A bioprosthetic aortic valve was inserted in both phantoms. Haemodynamic measurements were performed in a pulsatile flow-loop replicating physiological flow and pressure conditions. The flow in the aortic root was visualized by injecting contrast agent (CA). The distribution of the CA was captured by a high-speed camera, and image post-processing was performed to quantify CA distribution in the aortic sinus. The results were compared with angiographic images after a transcatheter aortic valve implant. Blood flow in the aortic root and the washout of the sinus portion are significantly affected by aortic root morphology. CA arrives at the aortic sinus of the 2 phantoms at 0.09 s and 0.16 s after the valve opens in the symmetrical and the patient-specific phantoms, respectively. Delayed CA arrival was also observed in the patients with a transcatheter aortic valve implant. Aortic root morphology affects the blood flow in the aortic sinus and may be a factor in bioprosthetic valve thrombosis. Therefore, patient-specific aortic root morphology should be considered when selecting and positioning a prosthesis.

Report this publication

Statistics

Seen <100 times