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Transcatheter Heart Valve Downstream Fluid Dynamics in an Accelerated Evaluation Environment

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Abstract

Transcatheter aortic valve replacements (TAVRs) provide minimally invasive delivery of bioprosthetic heart valves (BHVs) for the treatment of aortic valve disease. While surgical BHVs show efficacy for 8-10 years, long-term TAVR durability remains unknown. Pre-clinical testing evaluates BHV durability in an ISO:5840 compliant accelerated wear tester (AWT), yet, the design and development of AWTs and their accuracy in predicting in vivo performance, is unclear. As a result of limited knowledge on AWT environment and BHV loading, durability assessment of candidate valves remains fundamentally empirical. For the first time, high-speed particle image velocimetry quantified an ISO:5840 compliant downstream AWT velocity field, Reynolds stresses, and turbulence intensity. TAVR enface imaging quantified the orifice area and estimated the flow rate. When valve area and flow rate were at their maximum during peak systole (1.49 cm2 and 16.05 L/min, respectively), central jet velocity, Reynolds normal and shear stress, and turbulence intensity grew to 0.50 m/s, 265.1 Pa, 124.6 Pa, and 37.3%, respectively. During diastole, unique AWT recirculation produced retrograde flow and the directional changes created eddies. These novel AWT findings demonstrated a substantially reduced valve fully loaded period and pressure not matching in vivo or in vitro studies, despite the comparable fluid environment and TAVR motion.

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Acknowledgments

This research was supported by NIH HL129077 and the Leighton Riess Graduate Fellowship in Engineering from the Penn State Center for Biodevices.

Conflict of Interest

No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

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Authors and Affiliations

  1. Department of Biomedical Engineering, The Pennsylvania State University, Chemical and Biomedical Engineering Building, 122, University Park, PA, 16802, USA

    Sailahari V. Ponnaluri, Steven Deutsch & Keefe B. Manning

  2. Department of Biomedical Engineering, James T. Willerson Center for Cardiovascular Modeling and Simulation, Oden Institute for Computational Engineering Sciences, University of Texas, Austin, TX, USA

    Michael S. Sacks

  3. Department of Surgery, Penn State Hershey Medical Center, Hershey, PA, USA

    Keefe B. Manning

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  1. Sailahari V. Ponnaluri
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Correspondence to Keefe B. Manning.

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Ponnaluri, S.V., Deutsch, S., Sacks, M.S. et al. Transcatheter Heart Valve Downstream Fluid Dynamics in an Accelerated Evaluation Environment. Ann Biomed Eng 49, 2170–2182 (2021). https://doi.org/10.1007/s10439-021-02751-w

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