Patient specific finite element analysis results in more accurate prediction of stent fractures: Application to percutaneous pulmonary valve implantation |
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| Authors: | Silvia Schievano Andrew M Taylor Claudio Capelli Philipp Lurz Johannes Nordmeyer Francesco Migliavacca Philipp Bonhoeffer |
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| Institution: | 1. Cardiothoracic Unit, UCL Institute of Child Health and Great Ormond Street Hospital for Children, London WC1N 3JH, UK;2. Laboratory of Biological Structure Mechanics, Structural Engineering Department, Politecnico di Milano, Milan, Italy;1. State Key Laboratory for Strength and Vibration of Mechanical Structures, School of Aerospace Engineering, Xi’an Jiaotong University, Xi’an 710049, China;2. State Key Laboratory for Mechanical Behavior of Materials, School of Materials Science and Engineering, Xi’an Jiaotong University, Xi’an 710049, China;1. Department of Mechanical Engineering, Babol University of Technology, Babol, Iran;2. Department of Textile and Apparel, Qaemshahr Branch, Islamic Azad University, Qaemshahr, Iran;3. Young Researchers and Elite Club, Qaemshahr Branch, Islamic Azad University, Qaemshahr, Iran;1. Department of Cardiac Surgery, Boston Children''s Hospital, Boston, Mass;2. Division of Materials Science and Engineering, Boston University, Boston, Mass;1. Harvard Combined Orthopaedic Residency Program, 55 Fruit Street, Boston, MA 02115, USA;2. Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA 02215, USA;1. Dipartimento di Ingegneria Civile e Architettura, Università di Pavia, Via Ferrata 3, 27100 Pavia, Italy;2. Laboratoire de Mécanique des Solides - CNRS UMR 7649, École Polytechnique, 91128 Palaiseau cedex, France |
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| Abstract: | Stent fracture is a recognised complication following device implantation. Magnetic resonance data from a patient who underwent percutaneous pulmonary valve implantation (PPVI) and had subsequent stent fractures was used to create a finite element (FE) model of the patient's implantation site. Simulated expansion of the PPVI stent into this right ventricular outflow tract (RVOT) geometry was compared with free expansions of the PPVI stent up to a uniformly deployed configuration (conventional method employed in bench testing protocols), using FE analysis. PPVI biplane fluoroscopy images from the same patient were used to reconstruct the 3D shape and deformation of the stent in-situ and verify the FE geometrical results. Asymmetries were measured in all 3 orthogonal directions, in early systole and diastole.Although a simplified FE modelling of stent/implantation site interaction was adopted, this analysis gave useful information about the influence of the RVOT on the final geometry and mechanical performance of the stent. When deployed into the RVOT, the FE stent showed a non-uniform shape, similar to the geometry seen in the “real” fluoroscopy reconstructed stent, where the most expanded cells corresponded to the fracture locations. This asymmetrical geometry, when compared to the free-expanded stent, resulted in higher stresses in the portion of the stent where fractures occurred. Furthermore, fatigue fractures that were not predicted in the free-deployed stents, developed in the asymmetrically expanded device.In conclusion, the interaction between the PPVI device and the patient's RVOT is likely to be the crucial factor involved with this undesired event. |
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