PMID- 38014278
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240211
DP  - 2023 Nov 16
TI  - Effect of Sinotubular Junction Size on TAVR Leaflet Thrombosis: A Fluid-structure 
      Interaction Analysis.
LID - 2023.11.13.23298476 [pii]
LID - 10.1101/2023.11.13.23298476 [doi]
AB  - PURPOSE: TAVR has emerged as a standard approach for treating severe aortic 
      stenosis patients. However, it is associated with several clinical complications, 
      including subclinical leaflet thrombosis characterized by Hypoattenuated Leaflet 
      Thickening (HALT). A rigorous analysis of TAVR device thrombogenicity considering 
      anatomical variations is essential for estimating this risk. Clinicians use the 
      Sinotubular Junction (STJ) diameter for TAVR sizing, but there is a paucity of 
      research on its influence on TAVR devices thrombogenicity. METHODS: A Medtronic 
      Evolut(R) TAVR device was deployed in three patient models with varying STJ 
      diameters (26, 30, and 34mm) to evaluate its impact on post-deployment 
      hemodynamics and thrombogenicity, employing a novel computational framework 
      combining prosthesis deployment and fluid- structure interaction analysis. 
      RESULTS: The 30 mm STJ patient case exhibited the best hemodynamic performance: 
      5.94 mmHg mean transvalvular pressure gradient (TPG), 2.64 cm (2) mean geometric 
      orifice area (GOA), and the lowest mean residence time (T (R) ) - indicating a 
      reduced thrombogenic risk; 26 mm STJ exhibited a 10 % reduction in GOA and a 35% 
      increase in mean TPG compared to the 30 mm STJ; 34 mm STJ depicted hemodynamics 
      comparable to the 30 mm STJ, but with a 6% increase in T (R) and elevated 
      platelet stress accumulation. CONCLUSION: A smaller STJ size impairs adequate 
      expansion of the TAVR stent, which may lead to suboptimal hemodynamic 
      performance. Conversely, a larger STJ size marginally enhances the hemodynamic 
      performance but increases the risk of TAVR leaflet thrombosis. Such analysis can 
      aid pre- procedural planning and minimize the risk of TAVR leaflet thrombosis.
FAU - Oks, David
AU  - Oks D
FAU - Reza, Symon
AU  - Reza S
AUID- ORCID: 0000-0003-0225-7726
FAU - Vazquez, Mariano
AU  - Vazquez M
FAU - Houzeaux, Guillaume
AU  - Houzeaux G
FAU - Kovarovic, Brandon
AU  - Kovarovic B
FAU - Samaniego, Cristobal
AU  - Samaniego C
FAU - Bluestein, Danny
AU  - Bluestein D
AUID- ORCID: 0000-0002-4014-2308
LA  - eng
PT  - Preprint
DEP - 20231116
PL  - United States
TA  - medRxiv
JT  - medRxiv : the preprint server for health sciences
JID - 101767986
UIN - Ann Biomed Eng. 2023 Dec 14;:. PMID: 38097896
PMC - PMC10680880
EDAT- 2023/11/28 06:42
MHDA- 2023/11/28 06:43
PMCR- 2023/11/27
CRDT- 2023/11/28 04:04
PHST- 2023/11/28 06:43 [medline]
PHST- 2023/11/28 06:42 [pubmed]
PHST- 2023/11/28 04:04 [entrez]
PHST- 2023/11/27 00:00 [pmc-release]
AID - 2023.11.13.23298476 [pii]
AID - 10.1101/2023.11.13.23298476 [doi]
PST - epublish
SO  - medRxiv [Preprint]. 2023 Nov 16:2023.11.13.23298476. doi: 
      10.1101/2023.11.13.23298476.