Treffer: Mechanism of balloon burst during transcatheter aortic valve replacement pre-dilatation: Image observation and validation by finite element analysis.

Title:
Mechanism of balloon burst during transcatheter aortic valve replacement pre-dilatation: Image observation and validation by finite element analysis.
Authors:
Zhang X; International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Cardiology, Key Laboratory of Panvascular Diseases of Wenzhou, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Wu H; School of the Second Clinical Medical Sciences, Wenzhou Medical University, Wenzhou, China., Pan Z; The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Elkoumy A; Islamic Center of Cardiology, Al-Azhar University, Cairo, Egypt; Discipline of Cardiology, Saolta Group, Galway University Hospital, Health Service Executive and CORRIB Core Lab, University of Galway, Ireland., Ruan Z; International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Wu T; International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Wu D; International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China., Soliman O; Islamic Center of Cardiology, Al-Azhar University, Cairo, Egypt., Wu L; International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Cardiology, Key Laboratory of Panvascular Diseases of Wenzhou, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. Electronic address: 1187263152@qq.com., Wu X; International Joint Laboratory for Precise Diagnosis and Treatment of Heart Valve Disease of Zhejiang Province, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China; Department of Cardiology, Key Laboratory of Panvascular Diseases of Wenzhou, The Second Affiliated Hospital of Wenzhou Medical University, Wenzhou, China. Electronic address: xinlei.wu@wmu.edu.cn.
Source:
Computers in biology and medicine [Comput Biol Med] 2024 Jan; Vol. 168, pp. 107714. Date of Electronic Publication: 2023 Nov 23.
Publication Type:
Journal Article; Research Support, Non-U.S. Gov't
Language:
English
Journal Info:
Publisher: Elsevier Country of Publication: United States NLM ID: 1250250 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1879-0534 (Electronic) Linking ISSN: 00104825 NLM ISO Abbreviation: Comput Biol Med Subsets: MEDLINE
Imprint Name(s):
Publication: New York : Elsevier
Original Publication: New York, Pergamon Press.
MeSH Terms:
Transcatheter Aortic Valve Replacement*/methods , Aortic Valve Stenosis*/diagnostic imaging , Aortic Valve Stenosis*/surgery , Heart Valve Diseases* , Calcinosis*/diagnostic imaging , Calcinosis*/surgery , Heart Valve Prosthesis*, Humans ; Aortic Valve/diagnostic imaging ; Aortic Valve/surgery ; Dilatation ; Computer Simulation ; Finite Element Analysis ; Treatment Outcome ; Prosthesis Design
Contributed Indexing:
Keywords: Balloon rupture; Bicuspid aortic valve; Computational modeling; Transcatheter aortic valve replacement
Entry Date(s):
Date Created: 20231130 Date Completed: 20240110 Latest Revision: 20240206
Update Code:
20250114
DOI:
10.1016/j.compbiomed.2023.107714
PMID:
38035862
Database:
MEDLINE

Weitere Informationen

Background: Balloon burst during transcatheter aortic valve replacement (TAVR) is serious complication. This study pioneers a novel approach by combining image observation and computer simulation validation to unravel the mechanism of balloon burst in a patient with bicuspid aortic valve (BAV) stenosis.
Method: A new computational model for balloon pre-dilatation was developed by incorporating the element failure criteria according to the Law of Laplace. The effects of calcification and aortic tissue material parameters, friction coefficients, balloon types and aortic anatomy classification were performed to validate and compare the expansion behavior and rupture mode of actual balloon.
Results: Balloon burst was dissected into three distinct stages based on observable morphological changes. The mechanism leading to the complete transverse burst of the non-compliant balloon initiated at the folding edges, where contacted with heavily calcified masses at the right coronary sinus, resulting in high maximum principal stress. Local sharp spiked calcifications facilitated rapid crack propagation. The elastic moduli of calcification significantly influenced balloon expansion behavior and crack morphology. The simulation case of the calcific elastic modulus was set at 12.6 MPa could closely mirror clinical appearance of expansion behavior and crack pattern. Furthermore, the case of semi-compliant balloons introduced an alternative rupture mechanism as pinhole rupture, driven by local sharp spiked calcifications.
Conclusions: The computational model of virtual balloons could effectively simulate balloon dilation behavior and burst mode during TAVR pre-dilation. Further research with a larger cohort is needed to investigate the balloon morphology during pre-dilation by using this method to guide prosthesis sizing for potential favorable outcomes.
(Copyright © 2023 The Authors. Published by Elsevier Ltd.. All rights reserved.)

Declaration of competing interest All authors declared that they have no conflict of interest.