Please cite this article in press as: Auricchio F, et al. A computational tool to support pre-operative planning of stentless aortic valve implant. Med Eng Phys (2011), doi:10.1016/j.medengphy.2011.05.006 ARTICLE IN PRESS G Model JJBE-1889; No. of Pages 10 Medical Engineering & Physics xxx (2011) xxx–xxx Contents lists available at ScienceDirect Medical Engineering & Physics jou rnal h omepa g e: www.elsevier.com/locate/medengphy A computational tool to support pre-operative planning of stentless aortic valve implant F. Auricchio a,b,c , M. Conti a , S. Morganti a,∗ , P. Totaro d a Dipartimento di Meccanica Strutturale (DMS), Università degli Studi di Pavia, via Ferrata 1, 27100 Pavia, Italy b Istituto di Matematica Applicata e Tecnologie Informatiche (IMATI), CNR, Pavia, Italy c Centro di Simulazione Numerica Avanzata (CeSNA), IUSS, Pavia, Italy d Dipartimento di Chirurgia Cardiotoracovascolare, IRCCS Policlinico San Matteo, Pavia, Italy a r t i c l e i n f o Article history: Received 6 December 2010 Received in revised form 9 May 2011 Accepted 11 May 2011 Keywords: Finite Element Analysis (FEA) Patient-specific model Aortic valve replacement (AVR) a b s t r a c t In some cases of aortic valve leaflet disease, the implant of a stentless biological prosthesis represents an excellent option for aortic valve replacement (AVR). In particular, if compared to more classical surgical approaches, it provides a more physiological hemodynamic performance and a minor trombogeneticity avoiding the use of anticoagulants. The clinical outcomes of AVR are strongly dependent on an appro- priate choice of both prosthesis size and replacement technique, which are, at present, strictly related to surgeon’s experience and skill. Therefore, also this treatment, like most reconstructive procedures in cardiac surgery, remains “more art than science” [1]. Nowadays computational methodologies represent a useful tool both to investigate the aortic valve behavior, in physiologic and pathologic conditions and to reproduce virtual post-operative scenarios. The present study aims at supporting the AVR procedure planning through a patient-specific Finite Element Analysis (FEA) of stentless valve implantation. Firstly, we perform FEA to simulate the prosthesis placement inside the patient-specific aortic root; then, we reproduce, again by means of FEA, the diastolic closure of the valve to evaluate both the coaptation and the stress/strain state. The simulation results prove that both the valve size and the anatomical asymmetry of the Valsalva sinuses affect the prosthesis placement procedure. © 2011 IPEM. Published by Elsevier Ltd. All rights reserved. 1. Introduction Valvular heart pathologies represent a remarkable contribution to cardiovascular diseases (CVD) which are the major cause of death in the Western countries [2]. With respect to aortic valve, there are two main conditions which impair the native valve functionality: insufficiency and stenosis. In the first case, the valve is not able to close completely during diastole, causing blood regurgitation from the aorta to the left ventricle. In the second case, large calcium deposits on the valve contribute to the narrowing of its opening, thus reducing blood flow ejection. Different surgical treatments are adopted to restore valve functionality. In the literature many techniques for aortic root reconstruction are described, either sparing the valve leaflets [3,4], or involving the use of mechanical [5], stented [6,7] or stentless biological [8] prostheses as well as homograft and allograft valves [9,10]. ∗ Corresponding author. Tel.: +39 0382 985980. E-mail address: simone.morganti@unipv.it (S. Morganti). If the aortic root wall does not show any remarkable patholog- ical dilation so that the valvular leaflets can be considered as the principal cause of disease, the aortic valve is replaced by means of mechanical or biological valves: many comparative studies are reported in the literature [11–13]. On the one hand, mechanical prostheses assure a long-term solution due to an excellent durability [14], on the other hand, they are associated with a greater incidence of hemorrhage than bio- prostheses which avoid the use of anticoagulants and determine a more physiological hemodynamics as well as a minor tromboge- neticity [15]; accordingly, especially for elderly patients, biological valves assure greater performances than mechanical ones and, in particular, stentless valves are preferable than stented ones, repre- senting an “excellent option for aortic valve replacement” [16]. The use of stentless valves, in fact, appears to potentially increase the long-term survival when compared to stented ones due to improved ventricular reverse remodeling [17]. At the same time, the hemodynamics is closer to physiologic behavior; finally, the use of a continuous suture technique reduces the crossclamp times and cardiopulmonary bypass. The surgical treatment of the stentless valve implant can be summarized by three main steps as described in Fig. 1 adapted from Glauber et al. [8]: 1350-4533/$ – see front matter © 2011 IPEM. Published by Elsevier Ltd. All rights reserved. doi:10.1016/j.medengphy.2011.05.006