Canary in the cardiac-valve coal mine. Flow velocity and inferred shear during prosthetic valve closure –predictors of blood damage and clotting
Notice bibliographique
Résumé
ABSTRACT Objective To demonstrate a clear link between predicted blood shear forces during valve closure and thrombogenicity that explains the thrombogenic difference between tissue and mechanical valves and provides a practical metric to develop and refine prosthetic valve designs for reduced thrombogenicity. Methods Pulsatile and quasi-steady flow systems were used for testing. The time-variation of projected open area (POA) was measured using analog opto-electronics calibrated to projected reference orifice areas. Flow velocity determined over the cardiac cycle equates to instantaneous volumetric flow rate divided by POA. For the closed valve interval, data from quasi-steady back pressure/flow tests was obtained. Performance ranked by derived maximum negative and positive closing flow velocities, evidence potential clinical thrombogenicity via inferred velocity gradients (shear). Clinical, prototype and control valves were tested. Results Blood shear and clot potential from multiple test datasets guided empirical optimization and comparison of valve designs. Assessment of a 3-D printed prototype valve design (BV3D) purposed for early soft closure demonstrates potential for reduced thrombogenic potential. Conclusions The relationship between leaflet geometry, flow velocity and predicted shear at valve closure illuminated an important source of prosthetic valve thrombogenicity. With an appreciation for this relationship and based on our experiment generated comparative data, we achieved optimization of valve prototypes with potential for reduced thrombogenicity. Competing Interests None declared. Financial Disclosure This research has been done on a pro bono basis by all authors. Graphical Abstract Visualization of water jetting through closed mechanical heart valve under steady flow. Under pulsatile conditions, similar jet patterns near valve closure and leaflet rebound are likely. Dynamic metrics for several valves assessed in vitro are important in prediction of comparable blood cell damage and potential life-threatening thrombotic outcomes. Red star indicates moment of valve closure. CENTRAL MESSAGE A derived laboratory metric for valve closing flow velocity offers a way to rank valve models for potential blood damage. These results provide new insight and a mechanistic explanation for prior clinical observations where aortic and mitral valve replacements differ in thrombogenic potential and anticoagulation requirement. The study suggests a path forward to design and evaluate novel mechanical valve models for future development. As multiple modifications to mechanical and bioprosthetic valves have not resolved chronic shortcomings related to thrombogenicity and durability, a new development avenue was required to lead to eliminate thrombogenicity in the former and extend durability in the latter. PERSPECTIVE Prosthetic mechanical valve devices cause blood cell damage. Activation of the coagulation cascade is initiated by dynamic valve function. Design innovation focusing on valve closure behavior may reduce valve thrombogenic potential. Our study demonstrates that valve design can be empirically optimized with emphasis on that phase. SIGNIFICANCE Emphasis on open valve performance has encouraged a long-standing bias while under appreciation of the closing phase vital to identification of potential thrombogenic complications persist. Our multiple data sets are useful in challenging this bias. Dynamic motion(s) of mechanical valves and derived regional flow velocity are impacted by valve geometry. Focus on valve closure dynamics may lead to the development of potentially less thrombogenic prototype valves. Laboratory experiments support the supposition that valve regional flow velocity is associated with valve thrombogenic potential. This study compares three clinical valves and two experimental prototypes.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,001 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,000 |
| Bibliométrie | 0,001 | 0,000 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,001 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,001 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».