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Leaflet thrombosis is an increasingly recognized complication following transcatheter aortic valve-in-valve (ViV) implantation. This study aims to assess the risk of leaflet thrombosis following ViV implantation and compare it with that of surgical re-replacement of the degenerated bioprosthesis.
Idealized computational models of two ViV configurations, 26mm SAPIEN 3 and 26mm CoreValve in 25mm PERIMOUNT Magna bioprosthesis, were developed in a patient-specific geometry (Fig. 1a). The two ViV configurations were compared with surgical re-replacement of the degenerated bioprosthesis using 25mm Magna. Flow fields were calculated via a fluid-solid interaction modeling approach. In addition, calculation of the platelets/agonists (adenosine diphosphate, thromboxane A2, and thrombin) transport, agonists/shear-induced platelet activation, and platelet adhesion were embedded in the models.
The contours of blood residence time on the aortic side of the valve leaflets showed that the regions of high blood stasis were nearly 4 times larger in the SAPIEN 3 ViV model compared to the other two models. Similarly, the calculated species mass fractions demonstrated that that accumulation of activated platelets and agonists on the aortic side of the leaflets were highest for the SAPIEN 3 ViV model (Fig. 1b).
Risk of leaflet thrombosis is likely to be higher in SAPIEN 3 than CoreValve following ViV implantation. In addition, due to the increased presence of foreign materials, risk of leaflet thrombosis is likely to be higher in ViV implantation than surgical re-replacement of the bioprosthesis.
STRUCTURAL: Valvular Disease: Aortic