Aortic Biological Prosthetic Valve for Open-Surgery and Percutaneous Implant: Procedure Simulation and Performance Assessment Cardiovascular and Cardiac Therapeutic Device

Valvular heart disorders represent a remarkable contribution to cardiovascular diseases; in fact, more than 300,000 heart valve surgical operations were performed in 2006 worldwide. Such a huge social and economical problem calls for a dedicated multidisciplinary research, integrating different scientific fields, from medicine to engineering, along the various clinical steps, from diagnosis to treatment strategy. In particular, new manufacturing technologies and advanced materials are contributing to innovative devices for the replacement of aortic valves through minimally-invasive procedures, emerging as a valid alternative to classical open-chest surgery. Design, development and performance assessment of such devices are the natural field of application of computational biomechanics, which investigates the mechanical behaviour of biological systems and their interaction with artificial implants through the principle of mechanics. Moving from such considerations, we discuss from a biomechanical perspective the biological prostheses replacing the native aortic valve and implanted either through open-surgery or percutaneous procedures. Consequently, we focus on the use of patient-specific finite element analysis (FEA) to assess the structural performance of (i) a stentless biological prosthesis used for aortic valve replacement (AVR) and (ii) a transcatheter aortic valve implant (TAVI), where a biological valve sewn inside a stent, is crimped and properly placed in the patient’s heart by means of an endovascular procedure. From a more general point of view, our contribution underlines the potential role of computational biomechanics and realistic computer-based simulations in the surgical procedure planning, moving through a new paradigm in medicine which aims at reinforcing “diagnosis” with “prediction”.