PMID- 34859378 OWN - NLM STAT- MEDLINE DCOM- 20211231 LR - 20240426 IS - 1869-4098 (Electronic) IS - 1869-408X (Print) IS - 1869-408X (Linking) VI - 12 IP - 6 DP - 2021 Dec TI - Predictive Model for Thrombus Formation After Transcatheter Valve Replacement. PG - 576-588 LID - 10.1007/s13239-021-00596-x [doi] AB - PURPOSE: Leaflet thrombosis is a significant adverse event after transcatheter aortic valve (TAV) replacement (TAVR). The purpose of our study was to present a semi-empirical, mathematical model that links patient-specific anatomic, valve, and flow parameters to predict likelihood of leaflet thrombosis. METHODS: The two main energy sources of neo-sinus (NS) washout after TAVR include the jet flow downstream of the TAV and NS geometric change in volume due to the leaflets opening and closing. Both are highly dependent on patient anatomic and hemodynamic factors. As rotation of blood flow is prevalent in both the sinus of Valsalva and then the NS, we adopted the vorticity flux or circulation (capital GHE, Cyrillic) as a metric quantifying overall washout. Leaflet thrombus volumes were segmented based on hypo-attenuating leaflet thickening (HALT) in post-TAVR patient's gated computed tomography. capital GHE, Cyrillic was assessed using dimensional scaling as well as computational fluid dynamics (CFD) respectively and correlated to the thrombosis volumes using sensitivity and specificity analysis. RESULTS: capital GHE, Cyrillic in the NS, that accounted for patient flow and anatomic conditions derived from scaling arguments significantly better predicted the occurrence of leaflet thrombus than CFD derived measures such as stasis volumes or wall shear stress. Given results from the six patient datasets considered herein, a threshold capital GHE, Cyrillic value of 28.0 yielded a sensitivity and specificity of 100% where patients with Gamma < 28 developed valve thrombosis. A 10% error in measurements of all variables can bring the sensitivity specificity down to 87%. CONCLUSION: A predictive model relating likelihood of valve thrombosis using capital GHE, Cyrillic in the NS was developed with promising sensitivity and specificity. With further studies and improvements, this predictive technology may lead to alerting physicians on the risk for thrombus formation following TAVR. CI - (c) 2021. Biomedical Engineering Society. FAU - Hatoum, Hoda AU - Hatoum H AD - Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA. AD - Department of Biomedical Engineering, Michigan Technological University, Houghton, MI, USA. FAU - Singh-Gryzbon, Shelly AU - Singh-Gryzbon S AD - Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA. AD - Department of Chemical & Process Engineering, The University of the West Indies, St Augustine, Trinidad and Tobago. FAU - Esmailie, Fateme AU - Esmailie F AD - Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA. FAU - Ruile, Philipp AU - Ruile P AD - Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany. FAU - Neumann, Franz-Josef AU - Neumann FJ AD - Department of Cardiology and Angiology II, University Heart Center Freiburg-Bad Krozingen, Bad Krozingen, Germany. FAU - Blanke, Philipp AU - Blanke P AD - University of British Columbia and St. Paul's Hospital in Vancouver, Vancouver, Canada. FAU - Thourani, Vinod H AU - Thourani VH AD - Department of Cardiovascular Surgery, Marcus Heart Valve Center, Piedmont Heart Institute, Atlanta, GA, USA. FAU - Yoganathan, Ajit P AU - Yoganathan AP AD - Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA. FAU - Dasi, Lakshmi Prasad AU - Dasi LP AD - Department of Biomedical Engineering, Georgia Institute of Technology, 387 Technology Circle, Atlanta, GA, 30313, USA. lakshmi.dasi@gatech.edu. LA - eng GR - 19POST34380804/AHA/American Heart Association-American Stroke Association/United States GR - R01 HL119824/HL/NHLBI NIH HHS/United States PT - Journal Article PT - Research Support, N.I.H., Extramural PT - Research Support, Non-U.S. Gov't DEP - 20211202 PL - United States TA - Cardiovasc Eng Technol JT - Cardiovascular engineering and technology JID - 101531846 SB - IM EIN - Cardiovasc Eng Technol. 2022 Aug;13(4):516. PMID: 34997557 MH - Aortic Valve/diagnostic imaging/surgery MH - *Aortic Valve Stenosis/surgery MH - *Heart Valve Prosthesis/adverse effects MH - Hemodynamics MH - Humans MH - Hydrodynamics MH - Models, Cardiovascular MH - *Thrombosis/diagnostic imaging/etiology MH - *Transcatheter Aortic Valve Replacement/adverse effects MH - Treatment Outcome PMC - PMC11034843 MID - NIHMS1984678 OTO - NOTNLM OT - Flow stasis OT - Leaflet thrombosis OT - Neosinus OT - Predictive Model OT - Transcatheter aortic valve replacement COIS- CONFLICT OF INTEREST L.P. Dasi reports having patent applications filed on novel polymeric valves, vortex generators and super-hydrophobic/omniphobic surfaces. Ajit Yoganathan is a Consultant or Researcher for St. Jude Medical, Boston Scientific, Sorin Biomedica and Edwards Lifesciences. Vinod Thourani is a consultant for Abbott Vascular, Boston Scientific, Edwards Lifesciences, Cryolife, Shockwave, and Jenavalve. The other authors report no conflict. Hatoum, Singh-Gryzbon, Yoganathan, Thourani, and Dasi have filed patent application on computational predictive modeling of thrombosis in heart valves. EDAT- 2021/12/04 06:00 MHDA- 2022/01/01 06:00 PMCR- 2024/04/22 CRDT- 2021/12/03 07:17 PHST- 2021/01/12 00:00 [received] PHST- 2021/11/09 00:00 [accepted] PHST- 2021/12/04 06:00 [pubmed] PHST- 2022/01/01 06:00 [medline] PHST- 2021/12/03 07:17 [entrez] PHST- 2024/04/22 00:00 [pmc-release] AID - 10.1007/s13239-021-00596-x [pii] AID - 10.1007/s13239-021-00596-x [doi] PST - ppublish SO - Cardiovasc Eng Technol. 2021 Dec;12(6):576-588. doi: 10.1007/s13239-021-00596-x. Epub 2021 Dec 2.