• Phillip M Trusty, Sanchita S Bhat, Vahid Sadri, Md Tausif Salim, Emelia Funnell, Norihiko Kamioka, Rahul Sharma, Raj Makkar, Vasilis Babaliaros, and Ajit P Yoganathan.
• Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Ga.
• J. Thorac. Cardiovasc. Surg. 2022 Sep 1; 164 (3): e105-e117.

ObjectiveWith the recent expanded indication for transcatheter aortic valve replacement to low-risk surgical patients, thrombus formation in the neosinus is of particular interest due to concerns of reduced leaflet motion and long-term transcatheter heart valve durability. Although flow stasis likely plays a role, a direct connection between neosinus flow stasis and thrombus severity is yet to be established.MethodsPatients (n = 23) were selected to minimize potential confounding factors related to thrombus formation. Patient-specific 3-dimensional reconstructed in vitro models were created to replicate in vivo anatomy and valve deployment using the patient-specific cardiac output and idealized coronary flows. Dye was injected into each neosinus to quantify washout time as a measure of flow stasis.ResultsFlow stasis (washout time) showed a significant, positive correlation with thrombus volume in the neosinus (rho = 0.621, P < .0001). Neither thrombus volume nor washout time was significantly different in the left, right, and noncoronary neosinuses (P ≥ .54).ConclusionsThis is the first patient-specific study correlating flow stasis with thrombus volume in the neosinus post-transcatheter aortic valve replacement across multiple valve types and sizes. Neosinus-specific factors create hemodynamic and thrombotic variability within individual patients. Measurement of neosinus flow stasis may guide strategies to improve outcomes in transcatheter aortic valve replacement.Copyright © 2020 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

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