Abstract
The governing international standard for the development of prosthetic heart valves is International Organization for Standardization (ISO) 5840. This standard requires the assessment of the thrombus potential of transcatheter heart valve substitutes using an integrated thrombus evaluation. Besides experimental flow field assessment and ex vivo flow testing, computational fluid dynamics is a critical component of this integrated approach. This position paper is intended to provide and discuss best practices for the setup of a computational model, numerical solving, post-processing, data evaluation and reporting, as it relates to transcatheter heart valve substitutes. This paper is not intended to be a review of current computational technology; instead, it represents the position of the ISO working group consisting of experts from academia and industry with regards to considerations for computational fluid dynamic assessment of transcatheter heart valve substitutes.
Similar content being viewed by others
References
Adams, D. H., J. J. Popma, M. J. Reardon, S. J. Yakubov, J. S. Coselli, G. M. Deeb, et al. Transcatheter aortic-valve replacement with a self-expanding prosthesis. N. Engl. J. Med. 370(19):1790–1798, 2014. https://doi.org/10.1056/NEJMoa1400590.
Anand, M., and K. Rajagopal. A short review of advances in the modelling of blood rheology and clot formation. Fluids 2017. https://doi.org/10.3390/fluids2030035.
Ballyk, P. D., D. A. Steinman, and C. R. Ethier. Simulation of non-Newtonian blood flow in an end-to-side anastomosis. Biorheology 31(5):565–586, 1994.
Berg, P., S. Saalfeld, S. Voß, T. Redel, B. Preim, G. Janiga, et al. Does the DSA reconstruction kernel affect hemodynamic predictions in intracranial aneurysms? An analysis of geometry and blood flow variations. J. NeuroInterv. Surg. 13:290–296, 2017.
Bianchi, M., G. Marom, R. P. Ghosh, H. A. Fernandez, J. R. Taylor, Jr, M. J. Slepian, et al. Effect of balloon-expandable transcatheter aortic valve replacement positioning: a patient-specific numerical model. Artif. Org. 40(12):E292–E304, 2016. https://doi.org/10.1111/aor.12806.
Bluestein, D., S. Einav, and M. J. Slepian. Device thrombogenicity emulation: a novel methodology for optimizing the thromboresistance of cardiovascular devices. J. Biomech. 46(2):338–344, 2013. https://doi.org/10.1016/j.jbiomech.2012.11.033.
Bruening, J., F. Hellmeier, P. Yevtushenko, M. Kelm, S. Nordmeyer, S. H. Sündermann, et al. Impact of patient-specific LVOT inflow profiles on aortic valve prosthesis and ascending aorta hemodynamics. J. Comput. Sci. 2017. https://doi.org/10.1016/j.jocs.2017.11.005.
Chakravarty, T., L. Søndergaard, J. Friedman, O. De Backer, D. Berman, K. F. Kofoed, et al. Subclinical leaflet thrombosis in surgical and transcatheter bioprosthetic aortic valves: an observational study. The Lancet 6736(17):1–10, 2017. https://doi.org/10.1016/S0140-6736(17)30757-2.
Committee, V. Standard for verification and validation in computational fluid dynamics and heat transfer. New York: American Society of Mechanical Engineers, 2009.
Dasi, L. P., H. Hatoum, A. Kheradvar, R. Zareian, S. H. Alavi, W. Sun, et al. On the mechanics of transcatheter aortic valve replacement. Ann. Biomed. Eng. 45(2):310–331, 2017. https://doi.org/10.1007/s10439-016-1759-3.
De Marchena, E., J. Mesa, S. Pomenti, C. M. y Kall, X. Marincic, K. Yahagi, et al. Thrombus formation following transcatheter aortic valve replacement. JACC Cardiovasc. Interv. 8(5):728–739, 2015. https://doi.org/10.1016/j.jcin.2015.03.005.
Egbe, A. C., S. V. Pislaru, P. A. Pellikka, J. T. Poterucha, H. V. Schaff, J. J. Maleszewski, et al. Bioprosthetic valve thrombosis versus structural failure: clinical and echocardiographic predictors. J. Am. Coll. Cardiol. 66(21):2285–2294, 2015. https://doi.org/10.1016/j.jacc.2015.09.022.
Ferziger, J. H., and M. Peric. Computational Methods for Fluid Dynamics. Berlin: Springer, 2012.
Filipovic, N., D. Ravnic, M. Kojic, S. J. Mentzer, S. Haber, and A. Tsuda. Interactions of blood cell constituents: experimental investigation and computational modeling by discrete particle dynamics algorithm. Microvasc. Res. 75(2):279–284, 2008. https://doi.org/10.1016/j.mvr.2007.09.007.
Fogelson, A. L., and K. B. Neeves. Fluid mechanics of blood clot formation. Annu. Rev. Fluid Mech. 47(1):377–403, 2015. https://doi.org/10.1146/annurev-fluid-010814-014513.
Fraser, K. H., M. E. Taskin, B. P. Griffith, and Z. J. Wu. The use of computational fluid dynamics in the development of ventricular assist devices. Med. Eng. Phys. 33(3):263–280, 2011. https://doi.org/10.1016/j.medengphy.2010.10.014.
Fung, Y.-C. Biomechanics: Mechanical Properties of Living Tissues. New York: Springer, 1993.
Ge, L., S. C. Jones, F. Sotiropoulos, T. M. Healy, and A. P. Yoganathan. Numerical simulation of flow in mechanical heart valves: grid resolution and the assumption of flow symmetry. J. Biomech. Eng. 125(5):709–718, 2003. https://doi.org/10.1115/1.1614817.
Gravel, G. M., and P. Généreux. Exploring the role of transcatheter aortic valve replacement as the preferred treatment for lower-risk patients. J. Am. Coll. Cardiol. 66(14):1638–1639, 2015. https://doi.org/10.1016/j.jacc.2015.06.1346.
Hansson, N. C., E. L. Grove, H. R. Andersen, J. Leipsic, O. N. Mathiassen, J. M. Jensen, et al. Transcatheter aortic valve thrombosis: incidence, predisposing factors, and clinical implications. J. Am. Coll. Cardiol. 68(19):2059–2069, 2016. https://doi.org/10.1016/j.jacc.2016.08.010.
Hariharan, P., G. A. D’Souza, M. Horner, T. M. Morrison, R. A. Malinauskas, and M. R. Myers. Use of the FDA nozzle model to illustrate validation techniques in computational fluid dynamics (CFD) simulations. PLoS ONE. 12(6):e0178749, 2017. https://doi.org/10.1371/journal.pone.0178749.
Holmes, D. R., and M. J. Mack. Aortic valve bioprostheses: leaflet immobility and valve thrombosis. Circulation 135(18):1749–1756, 2017. https://doi.org/10.1161/CIRCULATIONAHA.116.025429.
Holzapfel, G. A., T. C. Gasser, and R. W. Ogden. A new constitutive framework for arterial wall mechanics and a comparative study of material models. J. Elast. 61(1–3):1–48, 2000. https://doi.org/10.1023/A:1010835316564.
International Standards O. ISO 5840-3:2013 cardiovascular implants—cardiac valve prostheses. Part 3: heart valve substitutes implanted by transcatheter techniques. 2013.
Karimi, S., M. Dabagh, P. Vasava, M. Dadvar, B. Dabir, and P. Jalali. Effect of rheological models on the hemodynamics within human aorta: CFD study on CT image-based geometry. J. Non-Newton. Fluid Mech. 207:42–52, 2014. https://doi.org/10.1016/j.jnnfm.2014.03.007.
Kheradvar, A., E. M. Groves, A. Falahatpisheh, M. K. Mofrad, S. Hamed Alavi, R. Tranquillo, et al. Emerging trends in heart valve engineering: part IV. Computational modeling and experimental studies. Ann. Biomed. Eng. 43(10):2314–2333, 2015. https://doi.org/10.1007/s10439-015-1394-4.
Laschinger, J. C., C. Wu, N. G. Ibrahim, and J. E. Shuren. Reduced leaflet motion in bioprosthetic aortic valves-the FDA perspective. N. Engl. J. Med. 373(21):1996–1998, 2015. https://doi.org/10.1056/NEJMp1512264.
Leetmaa, T., N. C. Hansson, J. Leipsic, K. Jensen, S. H. Poulsen, H. R. Andersen, et al. Early aortic transcatheter heart valve thrombosis: diagnostic value of contrast-enhanced multidetector computed tomography. Circ. Cardiovasc. Interv. 2015. https://doi.org/10.1161/circinterventions.114.001596.
Leon, M. B. Transcatheter aortic-valve implantation for aortic stenosis in patients who cannot undergo surgery. N. Engl. J. Med. 363(17):1597–1607, 2010. https://doi.org/10.1056/NEJMoa1008232.
Leon, M. B., C. R. Smith, M. J. Mack, R. R. Makkar, L. G. Svensson, S. K. Kodali, et al. Transcatheter or surgical aortic-valve replacement in intermediate-risk patients. N. Engl. J. Med. 374(17):1609–1620, 2016. https://doi.org/10.1056/NEJMoa1514616.
Makkar, R. R., G. Fontana, H. Jilaihawi, T. Chakravarty, K. F. Kofoed, O. de Backer, et al. Possible subclinical leaflet thrombosis in bioprosthetic aortic valves. N. Engl. J. Med. 373(21):2015–2024, 2015. https://doi.org/10.1056/NEJMoa1509233.
Malinauskas, R. A., P. Hariharan, S. W. Day, L. H. Herbertson, M. Buesen, U. Steinseifer, et al. FDA benchmark medical device flow models for CFD validation. ASAIO J. 63(2):150–160, 2017.
Mao, W., K. Li, and W. Sun. Fluid-structure interaction study of transcatheter aortic valve dynamics using smoothed particle hydrodynamics. Cardiovasc. Eng. Technol. 7(4):374–388, 2016. https://doi.org/10.1007/s13239-016-0285-7.
Marom, G. Numerical methods for fluid-structure interaction models of aortic valves. Arch. Comput. Methods Eng. 22(4):595–620, 2014. https://doi.org/10.1007/s11831-014-9133-9.
Marsden, A. L. Multi-scale modeling of cardiovascular flows. In: Computational Bioengineering. CRC Press, 2015, pp. 163–189.
Midha, P. A., V. Raghav, R. Sharma, J. F. Condado, I. U. Okafor, T. Rami, et al. The fluid mechanics of transcatheter heart valve leaflet thrombosis in the neo-sinus. Circulation 2017. https://doi.org/10.1161/CIRCULATIONAHA.117.029479.
Min Yun, B., C. K. Aidun, and A. P. Yoganathan. Blood damage through a bileaflet mechanical heart valve: a quantitative computational study using a multiscale suspension flow solver. J. Biomech. Eng. 136(10):101009, 2014. https://doi.org/10.1115/1.4028105.
Moghadam, M. E., F. Migliavacca, I. E. Vignon-Clementel, T.-Y. Hsia, and A. L. Marsden. Optimization of shunt placement for the Norwood surgery using multi-domain modeling. J. Biomech. Eng. 134(5):051002, 2012. https://doi.org/10.1115/1.4006814.
Nishimura, R. A., Otto, C. M., Bonow, R. O., Ruiz, C. E., Skubas, N. J., and Sorajja, P. 2014 AHA/ACC Guideline for the Management of Patients With Valvular Heart Disease A Report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines. 2014.
Oberkampf, W. L., and T. G. Trucano. Verification and validation benchmarks. Nucl. Eng. Des. 238(3):716–743, 2008. https://doi.org/10.1016/j.nucengdes.2007.02.032.
Piatti, F., F. Sturla, G. Marom, J. Sheriff, T. E. Claiborne, M. J. Slepian, et al. Hemodynamic and thrombogenic analysis of a trileaflet polymeric valve using a fluid-structure interaction approach. J. Biomech. 48(13):3650–3658, 2015. https://doi.org/10.1016/j.jbiomech.2015.08.009.
Piazza, N., B. Kalesan, N. van Mieghem, S. Head, P. Wenaweser, T. P. Carrel, et al. A 3-center comparison of 1-year mortality outcomes between transcatheter aortic valve implantation and surgical aortic valve replacement on the basis of propensity score matching among intermediate-risk surgical patients. JCIN 6(5):443–451, 2013. https://doi.org/10.1016/j.jcin.2013.01.136.
Popma, J. J., D. H. Adams, M. J. Reardon, S. J. Yakubov, N. S. Kleiman, D. Heimansohn, et al. Transcatheter aortic valve replacement using a self-expanding bioprosthesis in patients with severe aortic stenosis at extreme risk for surgery. J. Am. Coll. Cardiol. 63(19):1972–1981, 2014. https://doi.org/10.1016/j.jacc.2014.02.556.
Quarteroni, A., S. Ragni, and A. Veneziani. Coupling between lumped and distributed models for blood flow problems. Comput. Vis. Sci. 4(2):111–124, 2001. https://doi.org/10.1007/s007910100063.
Quarteroni, A., A. Veneziani, and C. Vergara. Geometric multiscale modeling of the cardiovascular system, between theory and practice. Comput. Methods Appl. Mech. Eng. 302:193–252, 2016. https://doi.org/10.1016/j.cma.2016.01.007.
Reporting of Computational Modeling Studies in Medical Device Submissions. https://www.fda.gov/downloads/MedicalDevices/DeviceRegulationandGuidance/GuidanceDocuments/UCM381813.pdf.
Sagar, A., and J. Varner. Dynamic modeling of the human coagulation cascade using reduced order effective kinetic models. Processes 3(4):178–203, 2015. https://doi.org/10.3390/pr3010178.
Schwer, L. E. An overview of the PTC 60/V&V 10: guide for verification and validation in computational solid mechanics. Eng. Comput. 23(4):245–252, 2007. https://doi.org/10.1007/s00366-007-0072-z.
Siguenza, J., D. Pott, S. Mendez, S. J. Sonntag, T. A. S. Kaufmann, U. Steinseifer, et al. Fluid-structure interaction of a pulsatile flow with an aortic valve model: a combined experimental and numerical study. Int. J. Numer. Method Biomed. Eng. 2017. https://doi.org/10.1002/cnm.2945.
Smith, C. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N. Engl. J. Med. 364(23):2187–2198, 2011. https://doi.org/10.1056/NEJMoa1103510.
Sonntag, S. J., M. Kutting, P. F. Ghalati, T. Kaufmann, J. Vazquez-Jimenez, U. Steinseifer, et al. Effect of pulmonary conduit oversizing on hemodynamics in children. Int. J. Artif. Org. 38(10):548–556, 2015. https://doi.org/10.5301/ijao.5000443.
Sun, W., C. Martin, and T. Pham. Computational modeling of cardiac valve function and intervention. Annu. Rev. Biomed. Eng. 16(1):53–76, 2014. https://doi.org/10.1146/annurev-bioeng-071813-104517.
Sun, W., and M. S. Sacks. Finite element implementation of a generalized Fung-elastic constitutive model for planar soft tissues. Biomech. Model. Mechanobiol. 4(2–3):190–199, 2005. https://doi.org/10.1007/s10237-005-0075-x.
Tamburino, C., M. Barbanti, P. D. E. Rs, M. Ranucci, F. Onorati, R. D. Covello, et al. 1-Year outcomes after transfemoral transcatheter or surgical aortic valve replacement. J. Am. Coll. Cardiol. 66(7):804–812, 2015. https://doi.org/10.1016/j.jacc.2015.06.013.
Taylor, J. O., B. C. Good, A. V. Paterno, P. Hariharan, S. Deutsch, R. A. Malinauskas, et al. Analysis of transitional and turbulent flow through the FDA benchmark nozzle model using laser doppler velocimetry. Cardiovasc. Eng. Technol. 7(3):191–209, 2016. https://doi.org/10.1007/s13239-016-0270-1.
Thyregod, H. G. H., S. Daniel Andreas, I. Nikolaj, and H. Nissen. Transcatheter versus surgical aortic valve replacement in patients with severe aortic valve stenosis. J. Am. Coll. Cardiol. 65(20):2184–2194, 2015. https://doi.org/10.1016/j.jacc.2015.03.014.
Toma, M., A. Krdey, S. Takagi, and M. Oshima. Strongly coupled fluid-structure interaction cardiovascular analysis with the effect of peripheral network. SEISAN KENKYU 63(3):339–344, 2011. https://doi.org/10.11188/seisankenkyu.63.339.
Tosenberger, A., F. Ataullakhanov, N. Bessonov, M. Panteleev, A. Tokarev, and V. Volpert. Modelling of platelet-fibrin clot formation in flow with a DPD-PDE method. J. Math. Biol. 72(3):649–681, 2016. https://doi.org/10.1007/s00285-015-0891-2.
Vy, P., V. Auffret, P. Badel, M. Rochette, H. Le Breton, P. Haigron, et al. Review of patient-specific simulations of transcatheter aortic valve implantation. Int. J. Adv. Eng. Sci. Appl. Math. 8(1):2–24, 2015. https://doi.org/10.1007/s12572-015-0139-9.
Wang, Q., S. Kodali, C. Primiano, and W. Sun. Simulations of transcatheter aortic valve implantation: implications for aortic root rupture. Biomech. Model Mechanobiol. 14(1):29–38, 2015. https://doi.org/10.1007/s10237-014-0583-7.
Wang, Q., C. Primiano, R. McKay, S. Kodali, and W. Sun. CT image-based engineering analysis of transcatheter aortic valve replacement. JACC Cardiovasc. Imaging 7(5):526–528, 2014. https://doi.org/10.1016/j.jcmg.2014.03.006.
Wei, Z. A., M. Tree, P. M. Trusty, W. Wu, S. Singh-Gryzbon, and A. Yoganathan. The advantages of viscous dissipation rate over simplified power loss as a fontan hemodynamic metric. Ann. Biomed. Eng. 2017. https://doi.org/10.1007/s10439-017-1950-1.
Wei, Z., and Z. C. Zheng. Mechanisms of wake deflection angle change behind a heaving airfoil. J. Fluid Struct. 48:1–13, 2014. https://doi.org/10.1016/j.jfluidstructs.2014.02.010.
Wei, Z. A., and Z. C. Zheng. Fluid-structure-interaction simulation on energy harvesting from vortical flows by a passive heaving foil. J. Fluids Eng. 140(1):011105, 2017.
Wu, W. T., M. A. Jamiolkowski, W. R. Wagner, N. Aubry, M. Massoudi, and J. F. Antaki. Multi-constituent simulation of thrombus deposition. Sci. Rep. 7:42720, 2017. https://doi.org/10.1038/srep42720.
Wu, W., D. Pott, B. Mazza, T. Sironi, E. Dordoni, C. Chiastra, et al. Fluid-structure interaction model of a percutaneous aortic valve: comparison with an in vitro test and feasibility study in a patient-specific case. Ann. Biomed. Eng. 44(2):590–603, 2016. https://doi.org/10.1007/s10439-015-1429-x.
Xu, Z., N. Chen, M. M. Kamocka, E. D. Rosen, and M. Alber. A multiscale model of thrombus development. J. R. Soc. Interface 5(24):705–722, 2008. https://doi.org/10.1098/rsif.2007.1202.
Xu, Z., J. Lioi, J. Mu, M. M. Kamocka, X. Liu, D. Z. Chen, et al. A multiscale model of venous thrombus formation with surface-mediated control of blood coagulation cascade. Biophys. J. 98(9):1723–1732, 2010. https://doi.org/10.1016/j.bpj.2009.12.4331.
Yun, B. M., L. P. Dasi, C. K. Aidun, and A. P. Yoganathan. Computational modelling of flow through prosthetic heart valves using the entropic lattice-Boltzmann method. J. Fluid Mech. 743:170–201, 2014. https://doi.org/10.1017/jfm.2014.54.
Yun, B. M., L. P. Dasi, C. K. Aidun, and A. P. Yoganathan. Highly resolved pulsatile flows through prosthetic heart valves using the entropic lattice-Boltzmann method. J. Fluid Mech. 754:122–160, 2014. https://doi.org/10.1017/jfm.2014.393.
Yun, B. M., D. B. McElhinney, S. Arjunon, L. Mirabella, C. K. Aidun, and A. P. Yoganathan. Computational simulations of flow dynamics and blood damage through a bileaflet mechanical heart valve scaled to pediatric size and flow. J. Biomech. 47(12):3169–3177, 2014. https://doi.org/10.1016/j.jbiomech.2014.06.018.
Zakaria, M. S., F. Ismail, M. Tamagawa, A. F. A. Aziz, S. Wiriadidjaja, A. A. Basri, et al. Review of numerical methods for simulation of mechanical heart valves and the potential for blood clotting. Med. Biol. Eng. Comput. 55(9):1519–1548, 2017. https://doi.org/10.1007/s11517-017-1688-9.
Acknowledgment
The authors would like to thank Dr. Ajit Yoganathan and other ISO TC 150 committee members for their suggestions and comments on the paper. Dr. Wei Sun and Dr. Simon Johannes Sonntag in the author list are ISO members, and Dr. Zhenglun Alan Wei, Dr. Milan Toma, and Dr. Shelly Singh-Gryzbon are not ISO members but they are experts in relevant fields who work with the ISO group to develop this document.
Conflict of interest
Zhenglun Wei, Milan Toma, Shelly Singh, and Wei Sun report no conflict of interest; Simon J. Sonntag is an employee of enmodes GmbH.
Author information
Authors and Affiliations
Corresponding author
Additional information
Associate Editors Karyn Kunzelman and Ajit P. Yoganathan oversaw the review of this article.
Rights and permissions
About this article
Cite this article
Wei, Z.A., Sonntag, S.J., Toma, M. et al. Computational Fluid Dynamics Assessment Associated with Transcatheter Heart Valve Prostheses: A Position Paper of the ISO Working Group. Cardiovasc Eng Tech 9, 289–299 (2018). https://doi.org/10.1007/s13239-018-0349-y
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s13239-018-0349-y