Details

Autor(en) / Beteiligte

• Shad, Rohan
• Kaiser, Alexander D
• Kong, Sandra
• Fong, Robyn
• Quach, Nicolas
• Bowles, Cayley
• Kasinpila, Patpilai
• Shudo, Yasuhiro
• Teuteberg, Jeffrey
• Woo, Y Joseph
• Marsden, Alison L
• Hiesinger, William

Titel

Patient-Specific Computational Fluid Dynamics Reveal Localized Flow Patterns Predictive of Post-Left Ventricular Assist Device Aortic Incompetence

Ist Teil von

• Circulation. Heart failure, 2021-07, Vol.14 (7), p.e008034-e008034

Ort / Verlag

United States

Erscheinungsjahr

2021

Quelle

MEDLINE

Beschreibungen/Notizen

• Progressive aortic valve disease has remained a persistent cause of concern in patients with left ventricular assist devices. Aortic incompetence (AI) is a known predictor of both mortality and readmissions in this patient population and remains a challenging clinical problem. Ten left ventricular assist device patients with de novo aortic regurgitation and 19 control left ventricular assist device patients were identified. Three-dimensional models of patients' aortas were created from their computed tomography scans, following which large-scale patient-specific computational fluid dynamics simulations were performed with physiologically accurate boundary conditions using the SimVascular flow solver. The spatial distributions of time-averaged wall shear stress and oscillatory shear index show no significant differences in the aortic root in patients with and without AI (mean difference, 0.67 dyne/cm [95% CI, -0.51 to 1.85]; =0.23). Oscillatory shear index was also not significantly different between both groups of patients (mean difference, 0.03 [95% CI, -0.07 to 0.019]; =0.22). The localized wall shear stress on the leaflet tips was significantly higher in the AI group than the non-AI group (1.62 versus 1.35 dyne/cm ; mean difference [95% CI, 0.15-0.39]; <0.001), whereas oscillatory shear index was not significantly different between both groups (95% CI, -0.009 to 0.001; =0.17). Computational fluid dynamics serves a unique role in studying the hemodynamic features in left ventricular assist device patients where 4-dimensional magnetic resonance imaging remains unfeasible. Contrary to the widely accepted notions of highly disturbed flow, in this study, we demonstrate that the aortic root is a region of relatively stagnant flow. We further identified localized hemodynamic features in the aortic root that challenge our understanding of how AI develops in this patient population.