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

Jahren, Silje Ekroll ; Heinisch, Paul Philipp ; Hasler, David ; Winkler, Bernhard Michael ; Stortecky, Stefan ; Pilgrim, Thomas ; Londono, Martina Correa ; Carrel, Thierry ; von Tengg-Kobligk, Hendrik ; Obrist, Dominik

In: Interactive CardioVascular and Thoracic Surgery, 2018, vol. 27, no. 1, p. 108-115

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    Titel
    • Can bioprosthetic valve thrombosis be promoted by aortic root morphology? An in vitro study
    Autor
    • Jahren, Silje Ekroll. ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
    • Heinisch, Paul Philipp. Department of Cardiovascular Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
    • Hasler, David. ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
    • Winkler, Bernhard Michael. Department of Cardiovascular Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
    • Stortecky, Stefan. Department of Cardiology, University Hospital Bern, University of Bern, Bern, Switzerland
    • Pilgrim, Thomas. Department of Cardiology, University Hospital Bern, University of Bern, Bern, Switzerland
    • Londono, Martina Correa. University Institute of Diagnostic, Interventional and Paediatric Radiology, University Hospital Bern, University of Bern, Bern, Switzerland
    • Carrel, Thierry. Department of Cardiovascular Surgery, University Hospital Bern, University of Bern, Bern, Switzerland
    • von Tengg-Kobligk, Hendrik. University Institute of Diagnostic, Interventional and Paediatric Radiology, University Hospital Bern, University of Bern, Bern, Switzerland
    • Obrist, Dominik. ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
    Dokumententyp
    • Postprint
    Sprache
    • Englisch
    Veröffentlicht in
    • Interactive CardioVascular and Thoracic Surgery, 2018, vol. 27, no. 1, p. 108-115. Oxford University Press
    Andere elektronische Ausgabe
    OAI-PMH-ID
    • oai:doc.rero.ch:332628
    Summary
    Abstract OBJECTIVES 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. METHODS 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. RESULTS 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. CONCLUSIONS 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.