Open Access

ARTICLE

Bioprosthetic Valve Size Selection to Optimize Aortic Valve Replacement Surgical Outcome: A Fluid-Structure Interaction Modeling Study

Caili Li¹, Dalin Tang^2,*,3, Jing Yao^4,*, Christopher Baird⁵, Haoliang Sun⁶, Chanjuan Gong⁷, Luyao Ma⁶, Yanjuan Zhang⁴, Liang Wang², Han Yu², Chun Yang⁸, Yongfeng Shao⁶
1 School of Mathematics, Southeast University, Nanjing, 210096, China
2 School of Biological Science & Medical Engineering, Southeast University, Nanjing, 210096, China
3 Mathematical Sciences Department, Worcester Polytechnic Institute, Worcester, MA 01609, USA
4 Department of Cardiology, First Affliated Hospital of Nanjing Medical University, Nanjing, 210029, China
5 Department of Cardiac Surgery, Boston Children’s Hospital, Harvard Medical School, Boston, MA 02115, USA
6 Department of Cardiovascular Surgery, First Affliated Hospital of Nanjing Medical University, Nanjing, 210029, China
7 Department of Anesthesiology, First Affliated Hospital of Nanjing Medical University, Nanjing, 210029, China
8 China Information Technology Designing & Consulting Institute Co., Ltd., Beijing, 100048, China
* Corresponding Authors: Dalin Tang. Southeast University. Email: ; Jing Yao. Email:
(This article belongs to this Special Issue: Computer Methods in Bio-mechanics and Biomedical Engineering)

Computer Modeling in Engineering & Sciences 2021, 127(1), 159-174. https://doi.org/10.32604/cmes.2021.014580

Received 10 October 2020; Accepted 23 December 2020; Issue published 30 March 2021

Abstract

Aortic valve replacement (AVR) remains a major treatment option for patients with severe aortic valve disease. Clinical outcome of AVR is strongly dependent on implanted prosthetic valve size. Fluid-structure interaction (FSI) aortic root models were constructed to investigate the effect of valve size on hemodynamics of the implanted bioprosthetic valve and optimize the outcome of AVR surgery. FSI models with 4 sizes of bioprosthetic valves (19 (No. 19), 21 (No. 21), 23 (No. 23) and 25 mm (No. 25)) were constructed. Left ventricle outflow track flow data from one patient was collected and used as model flow conditions. Anisotropic Mooney–Rivlin models were used to describe mechanical properties of aortic valve leaflets. Blood flow pressure, velocity, systolic valve orifice pressure gradient (SVOPG), systolic cross-valve pressure difference (SCVPD), geometric orifice area, and flow shear stresses from the four valve models were compared. Our results indicated that larger valves led to lower transvalvular pressure gradient, which is linked to better post AVR outcome. Peak SVOPG, mean SCVPD and maximum velocity for Valve No. 25 were 48.17%, 49.3%, and 44.60% lower than that from Valve No. 19, respectively. Geometric orifice area from Valve No. 25 was 52.03% higher than that from Valve No. 19 (1.87 cm² vs. 1.23 cm² ). Implantation of larger valves can signicantly reduce mean flow shear stress on valve leaflets. Our initial results suggested that larger valve size may lead to improved hemodynamic performance and valve cardiac function post AVR. More patient studies are needed to validate our findings.

---

Keywords

Fluid-structure interaction; aortic valve; aortic valve replacement; bioprosthetic valve; prosthesis–patient mismatch

---