The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

A Novel Method to Quantitate Bioprosthetic Valve Leaflet Mechanical Stress: A Numerical and In Vitro Study

1. Aix-Marseille Unis, IFSTTAR, LBA, Marseille, France, FRANCE
2. Aix Marseille Univ, IFSTTAR, LBA, Marseille, France
3. Aix Marseille Univ, IFSTTAR, LBA, Marseille, France
4. Aix Marseille Univ, IFSTTAR, LBA, Marseille, France
5. Polyclinique Les Fleurs, Ollioules, France
6. Aix Marseille Univ, IFSTTAR, LBA, Marseille, France
7. Aix Marseille Univ, IFSTTAR, LBA, Marseille, France
8. Quebec Heart and Lung Institute, Laval University, Quebec, Canada

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Aims: Calcified aortic stenoses are among the most prevalent form of cardiovascular diseases in the industrialized countries. This progressive disease with no effective medical therapy ultimately requires aortic valve replacement - either a surgical or very recently transcatheter aortic valve (TAV) implantation. As traditional surgical bioprosthetic valves, the TAV’s leaflet tissue is expected to calcify and degrade over time. In order to indirectly assess the durability of these valves, an original method was developed to estimate the values of local mechanical stress applied on the bioprosthetic valve’s leaflet.

Methods and results: For in-vitro testing, a double activation simulator was used, with a biological valve mounted in aortic position. A non-contact system based on stereophotogammetry and digital image correlation (DIC) with high spatial and temporal resolution (2000img/sec) enabled to film and study frame-by-frame the valve’s leaflet movement and perform the three-dimensional analysis. Secondly, a finite element model of the valve was developed. Finally, the deformation obtained from the DIC analysis was applied in the finite element model which allows a realistic opening and closing of each leaflet, in order to calculate the local mechanical stress applied. High stress regions were primarily observed in the upper leaflet edge and belly and to a lesser extent at the free leaflet edge. The maximum principal stress on leaflet reached to 1.97 MPa.

Conclusions:This coupled in-vitro/in-silico method offers a new experimental evaluation of the mechanical stress applied on bioprosthesis leaflets during in-vitro mechanical conditioning, which is important for better understanding of the valve durability.

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