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Biomechanical modeling of transcatheter aortic valve replacement in a stenotic bicuspid aortic valve: deployments and paravalvular leakage


Adi Morany(1), Karin Lavon(2), Gil Marom(1), and Rami Haj-Ali(1)


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Abstract:

Calcific aortic valve disease (CAVD) is characterized by stiffened aortic valve leaflets. Bicuspid aortic valve (BAV) is the most common congenital heart disease. Transcatheter aortic valve replacement (TAVR) is a treatment approach for CAVD where a stent with mounted bioprosthetic valve is deployed on the stenotic valve. Performing TAVR in calcified BAV patients may be associated with post-procedural complications due to the BAV asymmetrical structure. This study aims to develop refined computational models simulating the deployments of Evolut R and PRO TAVR devices in a representative calcified BAV. The paravalvular leakage (PVL) was also calculated by computational fluid dynamics simulations. Computed tomography scan of severely stenotic BAV patient was acquired. The 3D calcium deposits were generated and embedded inside a parametric model of the BAV. Deployments of the Evolut R and PRO inside the calcified BAV were simulated in five bioprosthesis leaflet orientations. The hypothesis of asymmetric and elliptic stent deployment was confirmed. Positioning the bioprosthesis commissures aligned with the native commissures yielded the lowest PVL (15.7 vs. 29.5 mL/beat). The Evolut PRO reduced the PVL in half compared with the Evolut R (15.7 vs. 28.7 mL/beat). The proposed biomechanical computational model could optimize future TAVR treatment in BAV patients.


Representative Results:



Paper Publication


Education

03/2019-02/2024:  Ph.D. in Mechanical Engineering

Mechanical Engineering School, Engineering Faculty, Tel Aviv University 

10/2016-12/2018: M.Sc. in Mechanical Engineering (Magna Cum Laude)

Mechanical Engineering School, Engineering Faculty, Tel Aviv University 

10/2010-04/2015:  B.Sc. in Aerospace Engineering

Faculty of Aerospace Engineering, Technion – Israel Institute of Technology, Haifa


Research Experience

Biomechanics of healthy and diseased aortic valve manners. 

Electromechanical simulation of full heart model.

Computational simulations of structural FEA, CFD 

Fluid-structure interaction (FSI) modeling approach for coupled FE structural analysis with Lattice Boltzmann Method (LBM)

Medical devices simulation; TAVR etc.

Calcific and fibrocalcific aortic valve disease progression; clinical and biomechanical modelling.

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