title: Simulation of transcatheter aortic valve implantation through patient-specific finite element analysis: two clinical cases.
abstract: Transcatheter aortic valve implantation (TAVI) is a minimally invasive procedure introduced to treat aortic valve stenosis in elder patients. Its clinical outcomes are strictly related to patient selection, operator skills, and dedicated pre-procedural planning based on accurate medical imaging analysis. The goal of this work is to define a finite element framework to realistically reproduce TAVI and evaluate the impact of aortic root anatomy on procedure outcomes starting from two real patient datasets. Patient-specific aortic root models including native leaflets, calcific plaques extracted from medical images, and an accurate stent geometry based on micro-tomography reconstruction are key aspects included in the present study. Through the proposed simulation strategy we observe that, in both patients, stent apposition significantly induces anatomical configuration changes, while it leads to different stress distributions on the aortic wall. Moreover, for one patient, a possible risk of paravalvular leakage has been found while an asymmetric coaptation occurs in both investigated cases. Post-operative clinical data, that have been analyzed to prove reliability of the performed simulations, show a good agreement with analysis results. The proposed work thus represents a further step towards the use of realistic computer-based simulations of TAVI procedures, aiming at improving the efficacy of the operation technique and supporting device optimization.
authors.affiliation: University of Pavia, Dept. of Industrial Eng. and Informatics, Via Ferrata 3, 27100 Pavia, Italy. Electronic address: simone.morganti@unipv.it.
authors.forename: S
authors.initials: S
authors.lastname: Morganti
authors.affiliation: University of Pavia, Dept. of Civil Eng. and Architecture, Via Ferrata 3, 27100 Pavia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Conti
authors.affiliation: IRCCS Policlinico San Matteo, Dept. of Cardiothoracic Surgery, Viale Golgi 19, 27100 Pavia, Italy.
authors.forename: M
authors.initials: M
authors.lastname: Aiello
authors.affiliation: IRCCS Policlinico San Matteo, Institute of Radiology, Viale Golgi 19, 27100 Pavia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Valentini
authors.affiliation: IRCCS Policlinico San Matteo, Dept. of Cardiothoracic Surgery, Viale Golgi 19, 27100 Pavia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Mazzola
authors.affiliation: University of Pavia, Dept. of Civil Eng. and Architecture, Via Ferrata 3, 27100 Pavia, Italy.
authors.forename: A
authors.initials: A
authors.lastname: Reali
authors.affiliation: University of Pavia, Dept. of Civil Eng. and Architecture, Via Ferrata 3, 27100 Pavia, Italy.
authors.forename: F
authors.initials: F
authors.lastname: Auricchio
mesh_terms: D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000601:surgery*; D002114:Calcinosis; D002404:Catheterization; D003198:Computer Simulation; D020342:Finite Element Analysis; D006350:Heart Valve Prosthesis; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D008953:Models, Anatomic; D015203:Reproducibility of Results; D015607:Stents; D014057:Tomography, X-Ray Computed
keywords: Aortic valve; Patient-specific modeling; Structural finite element; TAVI