A Computational Analysis of Annuloplasty in Bicuspid Aortic Valve Regurgitation

P0008 

Abstract Submission 

Jiayi Ju (1), Tianyang Yang (2), Shengzhang Wang (1)

(1) Fudan University, Shanghai, China, (2) Shanghai Chest Hospital, Shanghai, China

Jiayi Ju    -  Contact Me
Fudan University

Tianyang Yang    -  Contact Me
Shanghai Chest Hospital

Shengzhang Wang    -  Contact Me
Fudan University

Tianyang Yang    -  Contact Me
Shanghai Chest Hospital

A Computational Analysis of Annuloplasty in Bicuspid Aortic Valve Regurgitation

Jiayi Ju1, Tianyang Yang2, Shengzhang Wang1
1 Fudan University, Shanghai, China; 2 Shanghai Chest Hospital, Shanghai, China

Objective: To evaluate the impact of annuloplasty ring sizes on treating bicuspid aortic valve regurgitation through numerical simulation, which may provide insights into determining an optimal annuloplasty range for surgical procedures.
Method: CT images of a patient diagnosed with bicuspid aortic valve regurgitation and underwent annuloplasty surgery were utilized to establish patient-specific models in preoperative and postoperative conditions. The postoperative model was preprocessed to expand the annulus to align with the preoperative model, obtaining a model after procedures such as raphe relaxation and the free margin plication. Subsequently, elastic rings with diameters of 19,21,23,25 and 27 mm were generated, and the annular plane was remolded and constrained by these rings to simulate surgical annuloplasty process. After applying the physiological transvalvular pressure on the leaflets for finite element analysis, computational fluid dynamics method was employed to obtain hemodynamic information of the annuloplasty models at peak systole.
Results: As the annuloplasty ring size decreased, the leaflet coaptation area during early-diastole enhanced from 139 mm² preoperatively to a range of 247-416 mm² post-annuloplasty, concomitant with a reduction in stress at that location. Besides, annuloplasty led to a slight decrease in transvalvular pressure gradient and had minimal effect on the wall shear stress at the aorta. However, when reducing the annuloplasty ring diameter to less than 23 mm, folds manifested at the root of the leaflets, with the most significant folding occurring in case of 19 mm, reaching a ring area of 100 mm². Moreover, with an increased degree of annular remodeling, the annular plane exhibited stress concentration, accompanied by a significant elevation in wall shear stress in the adjacent region.
Conclusion: The computational analysis conducted on the selected patient indicates that annuloplasty by smaller-sized ring have both benefit on improving leaflet coaptation area and the mitigating of leaflet stress and transvalvular pressure gradient. Nevertheless, the use of excessively small ring may result in leaflet folding at the root and wall shear stress increasement at the annular plane region. Personalized annuloplasty simulation may be a valuable tool to provide the optimal size threshold for individual patients before surgery.

Aortic Root