Systems and methods for modeling the risk of transcatheter valve deployment - Patents.com

Abstract

A predictive model for classification of tissue rupture risk is generated by providing a computer-aided design CAD model suitable for simulating a balloon-expandable transcatheter heart valve and calculating stress, strain, and / or displacement in tissue upon expansion of the expandable transcatheter heart valve. The calculated stress, strain, and / or displacement in tissue allows for determination of low, medium, or high risk of tissue rupture upon expansion of the expandable transcatheter heart valve upon deployment in a patient.

Description

[Technical field]

[0001] This application claims priority to U.S. Provisional Patent Application No. 63 / 187,046, filed May 11, 2021, which is incorporated by reference in its entirety. [Background technology]

[0002] Aortic root rupture is a rare but potentially fatal complication after TAVR. The likelihood of aortic root rupture has been shown to increase with increasing calcification volume and is known to occur only in balloon-expandable transcatheter heart valves (THVs). Strategies to prevent rupture include selecting a smaller THV size than recommended by the manufacturer, under-expanding the THV by lowering the balloon filling volume, or using a self-expanding THV. However, these strategies increase the risk of paravalvular leakage and may create durability issues. A predictive algorithm that can take each of these risks into account could help better optimize balloon-expandable THV deployment to avoid root rupture as well as other complications.

[0003] Predicting root rupture from routine medical imaging is extremely challenging due to the complexity and variability of patient anatomy, as well as the dynamic nature of the TAVR procedure. Wang et al. performed a retrospective computational analysis measuring stress in native tissue after balloon-expandable THV deployment in one patient with aortic root rupture. The location of deployment was also identified to alter the stress in the aortic root. However, there are some limitations to measuring stress due to the high variability in patient vessel stiffness and thickness that cannot be measured from routine imaging. Therefore, it is worth measuring other parameters that are independent of these variables and unknown patient-specific characteristics. This would also allow for more qualitative risk metrics based on each of these quantitative measurements. Furthermore, computational modeling can capture these parameters at various balloon filling volumes, which may help optimize procedures based on risk parameters for aortic root rupture. Summary of the Invention [Problem to be solved by the invention]

[0004] Prior art methods of patient-specific virtual valve implantation only provide finite element simulations and are unable to accurately predict the optimal size of a valve implant uniquely tailored for each patient, thus failing to reduce procedural complications and further failing to incorporate the effects of the surrounding aortic tissues and structures. [Means for solving the problem]

[0005] Exemplary systems and methods are disclosed for prediction of aortic root rupture after transcatheter aortic valve replacement (TAVR). The exemplary systems and methods may be applied to mitigate the risk of aortic root rupture through optimization of balloon expansion volume in balloon-expandable TAVR. The exemplary systems and methods may be employed to measure aortic root rupture risk using stress, strain, and deflection in the aortic root after TAVR. The exemplary systems and methods may measure these metrics with varying deployment depths, varying angles, and eccentricities for further treatment optimization.

[0006] The exemplary systems and methods may be used for patient preclinical planning for treatment optimization. From the increased knowledge gained by the exemplary systems and methods, more suitable treatment approaches may be utilized.

[0007] In some aspects, the exemplary systems and methods employ a classification system that can detail the level of aortic root rupture risk based on how to quantify the more clinically significant aortic root rupture risk. The exemplary systems and methods may be used to simulate mechanical changes in calcified nodule shape and check whether the aortic root rupture risk has been mitigated. The exemplary systems and methods may be used to develop a training database of aortic root rupture cases for the purpose of identifying geometric predictors. The exemplary systems and methods may use machine learning, deep learning packages, or other reduced models that can be trained against these simulations to develop rapid identification of suspicious nodules and predictions of geometric and dynamic changes depending on current and future valve designs. The exemplary systems and methods may be used for 3D printing from the training database for further experimental validation.

[0008] The exemplary systems and methods can be used to pre-procedure assess the risk of aortic root rupture after TAVR and optimize clinical outcomes based on (1) computational simulation, (2) novel risk parameters, (3) risk stratification, and (4) deployment optimization through computational simulation.

[0009] In another aspect, exemplary systems and methods are disclosed that can be used to pre-operatively evaluate the success of implantation of a THV in a native or surgical heart valve (SHV), with and without expansion from a stent fracture, with and without modification to the leaflet tissue of the SHV, and to optimize the outcome of the procedure based on computational simulation results.

[0010] In another aspect, a predictive model for classification of tissue rupture risk is generated by providing a computer aided design (CAD) model suitable for simulating an expandable transcatheter heart valve and calculating stress, strain, and / or displacement in tissue upon expansion of the expandable transcatheter heart valve. The calculated stress, strain, and / or displacement in tissue allows for determination of low, medium, or high risk of tissue rupture upon expansion upon deployment of the expandable transcatheter heart valve in a patient.

[0011] In another aspect, a method for generating a predictive model for classification of tissue rupture risk includes providing a computer-aided design (CAD) model suitable for simulating an expandable transcatheter heart valve and calculating stress, strain, and / or displacement in tissue upon expansion of the expandable transcatheter heart valve. The calculated stress, strain, and / or displacement in tissue allows for determination of low, medium, or high risk of tissue rupture upon expansion upon deployment of the expandable transcatheter heart valve in a patient.

[0012] In another aspect, a patient-specific pre-operative model is generated by obtaining a patient CT scan, generating an anatomical model, and simulating THV deployment at multiple depths and angles of the THV, incision location or depth for BASILICA / LAMPOON, balloon fill volume and pressure, tissue alteration in the patient anatomical model to determine optimal procedural values ​​for each variable.

[0013] In another aspect, a method of pre-operatively assessing the success of a transcatheter heart valve replacement procedure in a patient includes obtaining a patient CT scan, generating a patient anatomical model, and simulating in the patient anatomical model the depth of THV deployment, angle of the THV, location or depth of incision for BASILICA / LAMPOON, balloon volume and pressure, tissue alteration to determine optimal procedural values ​​for each variable.

[0014] In another aspect, a method for predictive modeling of deformation of a transcatheter heart valve using reduced modeling includes obtaining a library of solutions for selective nodes with a first set of force boundary conditions applied to selective nodes of a transcatheter heart valve model via finite element simulation. The method also includes predicting deformation of the transcatheter heart valve under a second set of force boundary conditions for the selective nodes via the reduced model. The second set of force boundary conditions is different from the first set of force boundary conditions.

[0015] The novel features of the invention are set forth with particularity in the appended claims. A better understanding of the features and advantages of the present invention will be obtained by reference to the following detailed description that sets forth illustrative modes in which the principles of the invention are utilized, and the accompanying drawings in which: [Brief description of the drawings]

[0016] [Figure 1]FIG. 1 shows aortic valve segmentation in a retrospectively analyzed patient with the occurrence of aortic root rupture after TAVR (left) and aortic valve segmentation in a prospectively analyzed patient without the occurrence of aortic root rupture after TAVR (right). [Diagram 2] 1 shows strain, displacement (mm), and stress (MPa) in the area of ​​calcification protruding into native tissue plotted over balloon fill volume (%) in retrospectively analyzed patients with the occurrence of aortic root rupture after TAVR. Patients can be considered at medium risk if the parameters exceed the yellow dotted line, and at high risk if the parameters exceed the dotted line. [Diagram 3] 1 shows strain, displacement (mm), and stress (MPa) in the area of ​​calcification protruding into native tissue plotted over balloon fill volume (%) in prospectively analyzed patients without the occurrence of aortic root rupture after TAVR. Patients can be considered at medium risk if the parameters exceed the yellow dotted line and at high risk if the parameters exceed the dotted line. [Figure 4] FIG. 13 shows surface curvature contours for a patient with the development of a base rupture outlining the changes in local surface curvature following simulated balloon-expanded THV. [Diagram 5] 1 illustrates the variation of stress with deployment angle between a THV stent and the annulus. Stress increases and decreases in localized areas as the stent deployment is rotated relative to the annulus. [Figure 6] FIG. 13 illustrates an example of reduced modeling showing the displacement of a self-expanding stent represented by 15 nodes. [Figure 7] FIG. 13 is a flow chart of a method to simulate a virtual THV implantation in an SHV geometry from a patient-specific CT scan with an SHV fracture and / or tissue alteration. [Figure 8] Aortic valve segmentation in a patient with a defective biological aortic valve from pre-procedure CT imaging (left) and simulation of transcatheter heart valve implantation in a prospectively analyzed patient (right). [Figure 9] Segmentation of the SHV in a patient with a defective biological aortic valve (left) and modifications to the SHV leaflet geometry for simulation of THV implantation using BASILICA (right). [Figure 10A] FIG. 13 shows aortic valve segmentation (left) in a patient with a defective biological aortic valve from pre-procedure CT imaging. [Figure 10B] FIG. 13 shows a simulation of THV implantation without BASILICA in patients who underwent successful TAVR with BASILICA prospectively analyzed based on the results of the simulation. [Figure 10C] FIG. 13 shows a simulation of THV implantation with the BASILICA technique in patients who were prospectively analyzed and successfully underwent TAVR with BASILICA based on the results of the simulation. [Figure 11A] FIG. 13 shows CFD simulation results of flow into the coronary arteries after idealized TAVR deployment without BASILICA incision. [Figure 11B] FIG. 13 shows CFD simulation results of flow into the coronary arteries after idealized TAVR deployment with BASILICA incision. [Figure 12A] FIG. 1 shows segmentation of a defective biological aortic valve from pre-procedure CT imaging. [Figure 12B] FIG. 13 shows a virtual simulation of THV implantation inside a defective SHV without SHV ​​fracture. [Figure 12C] FIG. 13 shows high pressure balloon expansion to simulate fracture of a SHV implanted with a THV. [Figure 13] FIG. 13 shows the difference in THV stent diameter measured at the outflow, waist, and inflow locations of the THV between a hypothetical predictive simulation of THV implantation in a fractured SHV and in vitro experiments of a 20 mm THV in a fractured 19 mm SHV and a 23 mm THV in a fractured 21 mm SHV. [Figure 14A] FIG. 1 shows patient segmentation including the anterior and posterior mitral valve leaflets, left ventricle, left atrium, LVOT and calcification nodule. [Figure 14B] FIG. 14B shows the anterior leaflet and a large calcified nodule at the base of FIG. 14A. [Figure 14C] FIG. 13 shows a simulation of the LAMPOON procedure incised along the anterior leaflet to the calcified nodule. [Figure 15A] FIG. 13 shows the simulation results of SAPIEN 26mm without LAMPOON. [Figure 15B] FIG. 13 shows the simulation results of SAPIEN 26mm with LAMPOON. [Figure 15C] FIG. 13 shows the simulation results of SAPIEN 29mm without LAMPOON. [Figure 15D] FIG. 13 shows the simulation results of SAPIEN 29mm with LAMPOON. [Figure 16A] Neo-LVOT area assessment. Sectional view of pre-procedure CT scan overlaid with simulated SAPIEN 3 29mm results, showing ventricle and atrium in purple, anterior leaflet in orange, calcifications in blue, and stent in pink detail, with simplified stent implantation overlaid in teal blue. [Figure 16B] FIG. 11 is a three-dimensional rendering detailing the severity of the anterior leaflet and LVOT obstruction. [Figure 16C] FIG. 11 shows a comparison of the area of ​​the neo-LVOT between the simulated and simplified deployment methods, with the simulated method resulting in a much smaller area (73 mm2 compared to 282 mm2). [Figure 17A] CFD results detailing velocity contours through the Neo-LVOT. Without LAMPOON treatment, high peak velocities (6.1 m / s) were achieved. [Figure 17B] CFD results detailing velocity contours through the Neo-LVOT. With LAMPOON treatment, there was a lower peak velocity (5.0 m / s). [Figure 18] FIG. 1 shows a summary of the Reduced Order Modeling (ROM) framework, which can be split into an offline phase, where computationally expensive simulations are offloaded, and then an online phase, where the trained set is instantly recycled for a new set of parameters. [Figure 19A] FIG. 1 shows an idealised model of the Evolut R stent frame, from which three planes P1, P2 and P3 are defined and along which all force vs. boundary conditions are applied. [Figure 19B] Idealized model of the Evolut R stent frame. A sample force vs. boundary condition between two nodes of the stent is applied. [Figure 20A] FIG. 13 shows the eigenvalue decay of the stent deformation after POD implantation. [Figure 20B] FIG. 1 shows the calculated retention energies for each of the N trapped contracted bases. [Figure 21A] FIG. 21A shows a comparison between stent deformation from a ROM simulation (FIG. 21A) and a FOM finite element simulation (FIG. 21B) after simulating stent crimping. [Figure 21B] FIG. 21A shows a comparison between stent deformation from a ROM simulation (FIG. 21A) and a FOM finite element simulation (FIG. 21B) after simulating stent crimping. [Figure 22A] FIG. 13 shows a comparison between stent deformation from ROM simulation and FOM finite element simulation for stent expansion. [Figure 22B] FIG. 13 shows a comparison between stent deformation from ROM simulation and FOM finite element simulation for stent expansion. [Figure 23]FIG. 2 illustrates an example computer architecture for a computer system 200 capable of executing software components that can use output of the example methods described herein. DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

[0017] Example Method To demonstrate the feasibility of tissue rupture prediction, preoperative computed tomography scans were taken in two patients; one was analyzed retrospectively and the other was analyzed before the TAVR procedure. The retrospective analysis patient had a root rupture after TAVR, whereas the other did not. Both aortic valves were segmented, including the leaflets and calcifications, and balloon-expandable THVs were deployed in both anatomies (Figure 1). In patients with aortic root rupture caused by displacement of calcifications into the native tissue, large protrusions are seen (Figure 1). These protrusions are extremely difficult to predict from visual inspection alone on routine imaging. For example, clinical studies have observed that calcification volume increases the risk of aortic root rupture, but in this case, the calcification volume was significantly higher in patients without root rupture (1164 mm2 and 1164 mm3, respectively). 3 Calcification volume (with basal rupture) and 1701 mm 3 of calcification (without basal rupture).

[0018] The level of protrusion in these regions can be further quantified using multiple parameters including stress, strain, and displacement, which are plotted against the balloon fill volume for patients with (Figure 2) and without (Figure 3) base rupture.

[0019] Patients with root rupture are considered to be at higher rupture risk based on the stress and strain in the localized protruding area. These values ​​can also be characterized by implementing risk cutoff points for low, medium, and high risk of aortic root rupture. Exemplary cutoff values ​​are shown in Table 1. [Table 1]

[0020] Table 1 shows low, intermediate, and high risk aortic root rupture risk classification based on calculated measurements of stress (MPa), strain, and displacement (mm) in localized regions of calcified protrusion after simulated deployment of a balloon-expandable THV.

[0021] This risk of aortic root rupture has been confirmed to vary with balloon fill volume. If this analysis is done pre-procedure, it can aid clinical planning by giving the clinician an optimized fill volume that can be used during the procedure. This was demonstrated by two patients, one in a prospective analysis, who underwent TAVR with a lower balloon fill volume and did not experience a root rupture. Furthermore, this type of risk assessment provides a great deal of additional information that cannot be known by simply looking at the CT scan, as can be seen by the difference from a regular aortic root rupture risk assessment that uses only calcification volume, where the patient who did not have a root rupture had a significantly smaller calcification volume, but much higher stress and strain. Further analysis, such as changes in deployment depth, angle, and position, can be easily performed for further optimization. This analysis can also be easily performed for other valve replacement and stent deployment therapies. Additional metrics, such as local surface curvature change, can also be measured and correlated with aortic root rupture risk (Figure 4).

[0022] FIG. 4 shows surface curvature contours for a patient with the development of a base rupture outlining the change in local surface curvature following simulated balloon-expanded THV.

[0023] Further analysis such as changing the deployment depth, angle, and position can be easily performed for further optimization (Figure 5), which shows the stress variation with various deployment angles between the stent and the annulus.

[0024] In some embodiments, a training database of patients with and without aortic root rupture may be implemented. The database can take patient anatomical parameters and correlate them with the occurrence of aortic root rupture to better identify high-risk patients. Additionally, machine learning algorithms and reduced models can be implemented to rapidly identify suspicious calcified nodules and rapidly predict geometric and dynamic changes in the anatomy for any future valve design. A proof of concept of reduced modeling is shown in Figure 6.

[0025] Furthermore, developing a training database allows for the development of a threshold for balloon pressures that have a high risk of rupture. The balloon pressure can be measured during the procedure using an attached pressure gauge. To prevent the surgeon from accidentally exceeding the high-risk threshold, a locking mechanism can be implemented that automatically stops balloon filling if the balloon pressure exceeds a maximum threshold. This can be expanded to computationally determining the optimal device placement in terms of deployment depth, location, and balloon volume, and then rigorously performing this deployment in the patient using a precise robotic method that is programmable and has full control of the deployment device.

[0026] Finally, 3D prints from the training database may be used for further experimental validation.

[0027] Method for simulating stent deployment inside a stented tissue valve or native heart valve with geometry modifications - Patents.com Aortic stenosis is the most common cause of heart valve replacement. The treatment for aortic valve disease is surgical valve replacement, where a mechanical or biological valve is used to replace the incompetent native aortic valve. Patients with comorbidities that place them at risk of death with surgical valve replacement can be treated with transcatheter aortic valve replacement (TAVR), a minimally invasive alternative to replace diseased valves. TAVR has been shown to be effective not only in replacing native aortic valves, but also in replacing defective biological aortic valves in patients with a high risk of death if they were to undergo reoperation.

[0028] Coronary occlusion (CO) is a rare procedural complication during TAVR. It is a partial or complete blockage of blood flow in the coronary arteries, which originate from the aorta and supply oxygenated blood to the heart muscle. Unlike open-heart aortic valve replacement, the existing aortic valve leaflets are not removed during TAVR, resulting in a high probability of one or both coronary arteries being blocked by the deployment of the TAV device. Patients with defective bioprosthetic aortic valves undergoing TAVR are at increased risk of coronary artery obstruction because the bioprosthetic valve leaflets form a closed cylinder after implantation of the THV, which may stop coronary artery perfusion. Bioprosthetic or native aortic scallop intentional laceration to prevent iatrogenic coronary artery obstruction (BASILICA) is a novel technique developed to reduce the risk of coronary artery obstruction in patients undergoing TAVR. However, it is difficult to visualize how the leaflets of the SHV will settle after BASILICA and from conventional clinical imaging techniques. The angle of the incision relative to the leaflets, the depth of the incision, the implantation angle, depth, and the size of the THV may all affect the final position taken by the SHV leaflets and determine whether the risk of obstruction has been eliminated. Patient-specific computational modeling of THV implantation in a defective SHV may help optimize the technique and improve TAVR outcomes while preventing life-threatening complications.

[0029] Bioprosthetic valve fracture (BVF) has been demonstrated to increase the internal dimensions of the defective surgical valve, thereby allowing optimal expansion of the THV within the defective surgical valve while decreasing the pressure gradient and improving the effective orifice area (EOA). However, BVF may increase the risk of complications such as coronary artery occlusion and base rupture. Due to the complexities involved in the geometry and interaction of the SHV with the THV, it is difficult to predict the success of BVF from clinical imaging methods such as echocardiography or computed tomography (CT). Patient-specific computational modeling of BVF can assess the likelihood of achieving the intended hemodynamic success of BVF as well as identify the risk of adverse outcomes such as coronary artery occlusion or base rupture.

[0030] Patients with defective native or bioprosthetic heart valves at the mitral site who are considered to be at high risk for surgical valve replacement undergo transcatheter mitral valve replacement (TMVR). Left ventricular outflow tract (LVOT) obstruction is a potentially fatal complication after TMVR caused by protrusion of the native mitral valve anterior leaflet in the LVOT. LVOT obstruction can be characterized by an increased outflow velocity and an increased pressure gradient. Patients at high risk of LVOT obstruction undergo mitral valve anterior leaflet resection (LAMPOON technique) to reduce the risk of obstruction, thereby allowing additional blood to enter the LVOT. Accurate modeling of the risk of LVOT obstruction is important to appropriately select patients who can safely undergo TMVR. Currently, the only method to estimate LVOT obstruction is using CT imaging, which does not take into account the displacement of the anterior mitral leaflet and calcifications after THV implantation. Computational modeling of TMVR implantation with and without LAMPOON and subsequent hemodynamic studies can be used to optimize the technique and achieve superior clinical outcomes.

[0031] Exemplary methods and systems can be used to pre-procedure evaluate the success of THV implantation in SHVs with and without dilation from stent fractures and optimize clinical outcomes based on computational simulations. Figure 7 shows an exemplary method for simulating virtual THV implantation in SHV geometry from a patient-specific CT scan.

[0032] The exemplary methods described herein employ computational modeling techniques to provide a wealth of additional information that is typically not available to clinicians from CT scans. The techniques described above used during implantation of a THV in a SHV or a THV in native tissue can be virtually simulated and assessed using metrics such as coronary flow velocity to determine the likelihood of success in a patient using patient-specific modeling. Further analysis such as THV deployment depth, angle, incision location for BASILICA / LAMPOON, depth, balloon volume and pressure changes can be readily performed for further optimization.

[0033] Using the exemplary methods described herein, a predictive model can be developed to obtain the pressure gradient across the THV after implantation with and without geometry modification. Simulation of THV deployment with the addition of THV leaflets to the THV stent geometry can be used to obtain the geometric orifice area of ​​the transcatheter heart valve after implantation of the THV in the SHV with and without SHV ​​fracture and / or the THV in the native heart valve with tissue modification to the SHV or native heart valve. Further analysis using pre-operative echocardiography imaging data can obtain predictions of the pressure gradient across the heart valve, which determines the success of the valve replacement procedure, from just the virtual deployment of the THV in the patient-specific anatomy using FEA, without the need for costly CFD simulations.

[0034] The exemplary method may also implement a training database of patients with and without successful implantation of THVs in SHV implantation by BVF, BASILICA, or LAMPOON techniques. Additionally, artificial intelligence and / or machine learning algorithms and reduced models may be implemented to develop a training database of virtual simulations of THV deployment with tissue and geometry modifications for rapid identification of THV outcomes in SHVs and prediction of geometric and dynamic changes according to current and future valve designs. Finally, 3D prints from the training database will be used for further experimental validation.

[0035] To demonstrate the feasibility of modeling THV implantation in a defective SHV using BASILICA, pre-procedural CT images were prospectively acquired of a 74-year-old female patient with a defective 21 mm bioprosthetic aortic valve who was being considered for valve-in-valve TAVR. A patient-specific virtual model of the aortic root, bioprosthetic valve stent, and valve leaflets was reconstructed from the CT images and discretized using 3D tetrahedral elements (Figure 8).

[0036] FIG. 8 shows an aortic valve segmentation for a patient with a defective biological aortic valve.

[0037] Material models of the base, leaflets, and stent were obtained from the literature. To emulate the BASILICA technique, another model of the patient geometry was used in which incisions were made in the leaflet model geometry from the leaflet tip to the leaflet base in the left and right coronary leaflets of the SHV (Figure 9).

[0038] FIG. 9 shows aortic valve segmentation for a patient with a defective biological aortic valve and modifications to the geometry for simulation of THV implantation with tissue modifications.

[0039] A virtual THV implantation was simulated in both models by using the finite element method. DLC / d is a risk factor and is the ratio of the distance of the valve leaflet from the coronary ostium to the diameter of the coronary ostium. The risk factor DLC / d was used to assess the risk of coronary artery occlusion after THV implantation in SHV, and the results showed that DLC / d was 0.32 and 0.27 for the left and right coronary arteries, respectively, suggesting a very high risk of coronary artery occlusion. However, in the simulated BASILICA case, the occlusion in both coronary arteries was completely removed, and no SHV leaflet material was found in front of either coronary artery (Figure 10A-C).

[0040] The patient underwent successful TAVR with BASILICA bilaterally based on the modeling results, demonstrating the ability of the modeling in predicting the success of THV in SHV as well as tissue modification techniques used to prevent adverse outcomes in such procedures.

[0041] 11A-11B show simulation results of flow velocity into the coronary arteries with and without BASILICA for computational THV implantation.

[0042] To demonstrate the feasibility of modeling valve fracture and subsequent virtual implantation of a transcatheter aortic valve, a preoperative computed tomography scan was acquired of a patient with a defective bioprosthetic aortic valve compatible with BVF. Patient-specific geometric models of the aortic root, bioprosthetic valve were constructed from the CT images using segmentation techniques and discretized with 3D tetrahedral elements. The geometry of the THV was generated and discretized with hexahedral elements. The material models used for the aortic root, bioprosthetic valve, and THV were obtained from the literature. The geometry of the THV was generated and discretized with hexahedral elements. The virtual implantation of the THV in the defective SHV was simulated using finite element techniques (Figure 12B). After implantation of the THV, a high-pressure balloon was used to simulate the fracture of the SHV and to expand the area available for the THV inside the SHV (Figure 12C).

[0043] Comparison of THV diameters after virtual simulation of THV implantation measured at the outflow, waist, and inflow regions showed great agreement with measurements from the in vitro simulation of the same procedure (Figure 13).

[0044] It was demonstrated that the method used here can accurately predict BVF in virtual simulations of THV in SHV and further evaluation of the metric can be used in optimizing BVF for best treatment outcomes.

[0045] A 60-year-old female with severe mitral annular calcification (MAC) was studied who was being considered for THV implantation at the mitral valve site. A pre-procedure cardiac computed tomography (CT) was performed and acquired for analysis under an IRB approved protocol. The mitral valve, left ventricle, left atrium, aortic root, and calcification were segmented (Figure 14A-B). The geometry of the THV was generated and discretized using hexahedral elements. Material models were used from the literature. The LAMPOON procedure was simulated by removing a line of elements from the central free edge along the abdomen of the leaflet to the large calcified nodule at the base (Figure 14C).

[0046] Both stents were deployed with and without LAMPOON, and neo-LVOT area was observed in all four cases (Figures 15A-D).

[0047] As shown in Figures 16A-C, the neo-LVOT area was estimated by creating a spline through the neo-LVOT and measuring the minimum area. This was compared to a simplified method of neo-LVOT obstruction prediction consisting of superimposing a cylinder at the mitral valve site. For a 20 mm THV, there was a large difference in the area of ​​the neo-LVOT (282 mm) between the complex finite element simulation and the simplified stent deployment. 2 Compared to 73mm 2 ) was observed, with an area of ​​104 mm after LAMPOON. 2, but still about 2.7 times smaller than the simplified deployment method. This is likely due to the simplified deployment not considering the structural deformation of the anterior leaflet, the incomplete spreading of the leaflets after LAMPOON, and the irregular THV expansion caused by severe annular and leaflet calcification. The impact of LAMPOON was further investigated through the use of computational fluid dynamics (CFD) on post-simulation results, following the methods detailed in previous studies. 29 mm THV implantation with and without LAMPOON was analyzed. As shown in Figures 17A-B, the velocities through the neo-LVOT were higher without LAMPOON.

[0048] The pressure gradients between the left ventricle and the sinoaortic junction without and with LAMPOON were 156 and 86 mmHg, respectively. These high pressure gradients were observed in patients with a neo-LVOT area of ​​100 mm 2 This is consistent with clinical measurements reported in patients with less than 10 mmHg of LAMPOON. In this case, LAMPOON was not sufficient to prevent LVOT obstruction (pressure gradient >10 mmHg), there was a significant discrepancy in neo-LVOT area between the simulated and simplified models, with the simulated model predicting a high risk of LVOT obstruction and the simplified model predicting a low risk of LVOT obstruction.

[0049] In this way, high accuracy modeling can be used to better predict the neo-LVOT area and analyze patient hemodynamics before clinical procedures. It would be extremely meaningful to validate the method through its use in a larger number of patients undergoing postoperative CT and echocardiography. CFD can implement the flow over the cardiac cycle and the geometry of the native or biological aortic valve to provide temporal information on how LVOT obstruction affects the pressure gradient across the aortic valve. This provides information on how much LVOT obstruction may be tolerable in high-surgical-risk patients who only have transcatheter treatment options.

[0050] Through an iterative technique, the risk of complications can be optimized. This can be done by making changes in device position, balloon volume, location and length of the BASILICA / LAMPOON incision, etc. An optimal deployment can then be performed.

[0051] This technique can also be used in testing future device designs. The effectiveness of geometry modification techniques may not be consistent among all devices deployed. Furthermore, deployment simulations of new devices with and without natural geometry modifications can be performed and compared to current standard devices.

[0052] Using the exemplary methods described herein, various clinical scenarios can be simulated to assess the risk of complications versus device design parameters to identify optimal device designs for future THVs to prevent complications such as tissue rupture, coronary artery occlusion, LVOT occlusion, patient-prosthesis incompatibility, etc. The presented computational techniques can also be used to guide the development of new devices that allow control of incision depth and angle to improve procedures such as BASILICA / LAMPOON by virtually testing the devices in patient-specific geometries for feasibility testing and optimization.

[0053] The training database can also be used to test new device designs, such as by running virtual clinical trials. Simulations of the new design can be run in the training database and its performance with respect to the desired complication risk assessment can be compared to current standard devices. The training can then be used to assess risk for complications in patients outside the training database for the new device design.

[0054] Real-time predictive modeling of transcatheter heart valve deformation via reduced modeling Transcatheter aortic valve replacement (TAVR) has become an increasingly viable alternative to treat patients with severe aortic stenosis (AS), especially high-surgical-risk patients who cannot undergo traditional surgical valve replacement procedures. Within the TAVR pre-procedure planning pipeline, there is a need for accurate assessment of complications that may occur after the TAVR procedure, such as paravalvular leak, aortic root rupture, and coronary artery occlusion. Computational modeling can be an important tool to visualize and predict the deployment behavior for TAVR procedures, especially in relation to aortic root rupture.

[0055] Computational models are generally created using traditional computational techniques to solve the partial differential equations (PDEs) that govern the fundamental mechanics of the problem. These computational techniques involve expressing the true solution as an approximation, i.e., as a linear combination of functions involving a finite number of coefficients. Finite element (FE) methods are the most commonly used technique for predictive modeling of TAVR deployment, and these functions are typically piecewise polynomials defined over the mesh elements of interest in traditional commercial FE solvers such as Abaqus FEA. Specifically, in TAVR analysis, the process involves modeling the native aortic valve leaflets, aortic root, and calcification deposits, as well as the transcatheter heart valve (THV) stent frame and leaflets. However, due to the inherent geometric and mechanical complexity required to accurately model these components, the process becomes extremely computationally expensive due to the large number of coefficients required to solve the linear combination of functions. Furthermore, the combination of structural problems and their interaction with blood flow only increases the complexity of the model, which makes the process even more computationally expensive.

[0056] An exemplary method and system utilizing a reduced-modeling (ROM) framework for rapid prediction of THV structural deformation is disclosed, which serves as a first step toward real-time prediction of the entire TAVR deployment procedure. The exemplary method and system enable rapid calculation of THV deformation in response to a predefined load, which is important in any isolated computational method, optimization procedure, or more generally, iterative scheme where each step requires solving the problem multiple times under different conditions.

[0057] The exemplary system and method entails a two-phase approach with offline and online phases, where computationally expensive simulations are offloaded and performed in the offline phase, and then instantly recycled in the online phase for a rapid reduced solution. In the offline phase, multiple FE simulations are performed using 15 probe points from the THV model, with parameterized loads imposed on each point, to create a snapshot library of solutions. Specifically, these 15 nodes are predefined in the form of force pair conditions, where equal and opposing forces between the nodes are prescribed, resulting in a resultant force that points radially outward or inward of the stent geometry. Different combinations of these force pairs are imposed for each simulation, resulting in a unique deformation field that encompasses each entry in the snapshot library. The snapshot library is subsequently recycled in the online phase for a new set of applied loads on the same 15 points via a Proper Orthogonal Decomposition (POD) Galerkin approach. Overall, using this framework, the computational cost of simulating the structural deformation of a given THV in response to a set of defined loads can be significantly reduced.

[0058] A flow chart describing an exemplary methodology, mainly consisting of an offline phase and an online phase, is shown in Figure 18. Briefly, the offline phase starts with a set number of FE simulations with parameterized force boundary conditions at 15 probe points along the THV stent frame. This is followed by a reduction of the dimension of the snapshot library via a POD Galerkin approach to manipulate a uniform selection in the space of parameters, followed by filtering of possible redundancies in the snapshot library in a second stage. In the online phase, the filtered snapshot library is used to compile reduced basis functions, from which the ROM solution is computed.

[0059] Below, the offline phase, the idealized model of the THV, and the applied loads are presented. First, the 3D geometry of the THV of interest is required for utilization in the exemplary framework. The 3D valve geometry can be reconstructed from reverse engineering a micro-computed tomography (CT) scan of the valve. This process may be performed in a computer-aided design software (CAD) such as SolidWorks. In the following example, a 29 mm Medtronic Evolut R valve stent frame was reconstructed and utilized. Note that the framework can utilize any THV, only the 3D CAD geometry of the valve of interest is required. The idealized model used in this exemplary framework does not include the pericardial-based leaflets and skirt. This simplification in the model allowed the exemplary framework to focus only on the THV stent frame deformation as a first step towards full capture of TAVR deployment. To perform the FE simulation, an appropriate mesh of the Evolut valve was created using the open source platforms Netgen and Mmgtools. In the following example, the final mesh size was approximately 260,000 tetrahedral elements. Figure 18A shows an idealized model of the Evolut R valve stent frame.

[0060] To perform an FE simulation, the governing mechanics must be defined. In this framework, we first assume a linear elastic constitutive law, so that the governing problem for each simulation can be: ∇ σ = F, xεΩ (1)

[0061] where σ=λ(∇ u)I+2με is the Cauchy stress tensor and ε=1 / 2(∇u+∇u T) is the strain tensor. I denotes the identity tensor, F is the external body force, and λ and μ are the Lamé constants. More relevant nonlinear constitutive laws such as hyperelastic (generalized neo-Hookian model) or superelastic constitutive laws may be implemented in this framework to more accurately describe the governing dynamics of the THV. Using the governing equations, appropriate boundary conditions at the 15 probe points are imposed, in particular via “force couples”. At each of the 15 points, a normal stress is assumed to be given, i.e., σ·n(P for i=1,2,…,15). i )=d i where n is the outward normal unit vector. More specifically, we select all possible pairs between the 15 points and define d as a vector oriented along the line connecting the two end points of each pair. i We defined the force pairs. These "force pair" boundary conditions idealize the loads applied to the THV stent frame from the aortic wall and aortic root, and mimic the crimping and expansion of the stent frame during the deployment procedure. Furthermore, it can be shown that any generalized load on the stent frame can be accurately represented by a sum of force pairs. Utilizing these force pair conditions at 15 nodes avoids the need to impose boundary conditions at each of the hundreds of thousands of nodes that make up the stent geometry, thus reducing the complexity of the simulation. This simplification, in turn, only enhances the savings in computational cost expected from using the ROM framework. A sample force pair between two nodes of the Evolut stent frame is shown in Figure 19B, and we defined each of these force pairs along three planes P1, P2, and P3 along the stent frame as shown in Figure 19A.

[0062] Using these 15 force vs. boundary conditions, 105 FE simulations were run to form a snapshot library, which essentially serves as a training database that will be further utilized during the online phase.

[0063] Below we show the singular value decomposition of the snapshots. The generated snapshots are representations of the solution of the governing problem under different boundary conditions. Although each snapshot represents a different solution, the level of information each carries about the governing problem may be redundant. Since the ultimate goal of this exemplary framework is to compose a set of functions to be used for fast computation in the online phase, effective filtering of this redundancy is required to create an efficient process. A fundamental tool of linear algebra known as Singular Value Decomposition (SVD) is employed to filter out this redundancy. SVD states that given a general m×n matrix A, it can be factorized into three matrices as follows: A=UΣV T (2)

[0064] where U is an m × n orthogonal matrix whose columns are known as the left singular vectors of A (U T where U=I), V is an n×n orthogonal matrix whose columns are the right singular vectors of A, and Σ is an m×n diagonal matrix whose entries contain the singular values. These singular values ​​from matrix Σ are ordered in descending order, and the rapid decay in singular values ​​indicates high redundancy in the data set, which can be filtered such that key features of the snapshot data set can be captured by a linear combination of those left eigenvectors associated with the largest singular values.

[0065] Initial results after SVD of the generated snapshot library are shown in Figures 20A and 20B. A sharp and rapid decrease in singular values ​​is observed after approximately 13 reduced bases, suggesting that the entire full order model (FOM), i.e., FE problem, can be adequately approximated by the left eigenvectors associated with the first 13 principal components of the snapshot library. Furthermore, Figure 20B shows the calculated retained energy for each utilized reduced basis. The plot reaches a plateau at 13 reduced bases, which is consistent with the same number of principal components shown from Figure 20A, which corresponds to 99.99% of the energy captured from the snapshot library. Overall, this suggests that it is sufficient to use only the first 13 principal components to construct the reduced basis functions and calculate the reduced solution.

[0066] Below we present the proper orthogonal decomposition Galerkin approach. After discretization of the governing problem via FE methods, the FOM from Eq. 1 leads to the solution of a linear system in the following form: Au=b (3)

[0067] where u is the solution of interest (the resulting displacements), A is the stiffness matrix, and b is a vector that collects the effects of the forcing terms and the applied boundary conditions (force vs. conditions). The POD Galerkin approach involves creating an approximate solution to Equation 1 and substituting this form into Equation 3, resulting in the following reduced system: W T AWc=W T b (4)

[0068] In Equation 4, W is a matrix formed using the filtered left eigenvectors from the SVD analysis. In the online phase, we can solve for the "small" vector c using Equation 4 with vector b incorporating the new boundary conditions of interest, from which we obtain the final reduced solution. The computational cost savings are the size of A in Equation 3 and the reduced matrix W in Equation 4. TIt becomes clear when comparing matrix A with matrix AW, where matrix A can be hundreds of thousands or millions in size, whereas matrix W T The AW matrix is ​​characterized by a size in the range of tens or hundreds of rows, and therefore the computational cost required to solve the system in Equation 4 is much smaller.

[0069] The results of using this exemplary framework are presented below. Specifically, in the online phase of the ROM framework, the novel force boundary condition was applied and the resulting reduced solution was calculated. Using the same force boundary condition, a conventional FE simulation was also performed and the resulting displacements and stresses as well as the computational cost were compared between ROM and FOM. Two different types of simulations were performed. First, a simulation was performed in which a radially inward force was applied along each of the planes P1, P2, and P3, which essentially mimics the stent crimping due to the applied load from the aortic wall, and then a radially outward force was applied along each of the planes, which essentially mimics the stent expansion (e.g., due to the opening and closing of the THV leaflets). Figures 21A-B show the resulting displacements of the stent frame after the radially inward force was applied. As can be seen, there is no difference between the ROM solution (Figure 21A) and the FOM solution (Figure 21B), indicating that the exemplary framework provides accurate results compared to the conventional FE simulation.

[0070] 22A-B further show the resulting displacement after application of an outward radial force, which mimics stent expansion. Again, no differences are observed between the ROM solution (FIG. 22A) and the FOM solution (FIG. 22B), highlighting the accuracy of this framework.

[0071] The computational details of the above ROM and FOM simulations are summarized in Table 2. The FOM simulation required 227,511 degrees of freedom (corresponding to the number of nodes on the THV stent frame), while the ROM simulation used only 13 reduced basis sets to compute the online solution. It took an average of 122.28 seconds to simulate the FE solution of the FOM. The average computation time for the offline phase of the ROM was 2654.39 seconds, while the online phase of the ROM took only 2.14 seconds on average, a 98.25% reduction in computation time compared to the FOM simulation, or approximately 60 times faster.

[0072] Such model reduction approaches can be developed using common open source software and libraries. An open source Python-C++ based finite element library such as FEniCS can be used to perform the finite element simulation. The SVD analysis and POD Galerkin process can be performed using common numerical libraries in Python. Furthermore, the open source model reduction library RBniCS may be used to capture the entire process. In this case, the entire problem, from the offline phase to the model reduction as well as the analysis acceleration, is managed by the library. Table 2 shows a summary of the computational details for the FOM and ROM simulations. [Table 2]

[0073] Structural analysis of THVs has become an increasingly common area of ​​focus in gaining a deeper understanding of the physiological interactions between the valve and the native aortic geometry. Many in silico studies have shown the importance of the radial forces applied against the aortic annulus from self-expanding valves such as Evolut R during TAVR deployment, as well as the significance of aortic wall deformation in response to TAVR deployment. The magnitude of deformations seen above is similar to that found in traditional in silico studies, highlighting the accuracy of this framework. Furthermore, the uniform deformation of the Evolut valve seen in Figures 21A-B and 22A-B roughly mimics the deformation state the valve undergoes during physiological deployment. However, traditional FE methods used to model and predict pre-operative TAVR deployment require a large number of degrees of freedom and require extremely long computation times (up to 24-72 hours). Predicting the effects of various valve types and configurations for a single patient can require multiple simulations, making it impractical in a clinical setting where rapid and accurate predictive models are required. In the setting of a full TAVR deployment, these parameters may include the positioning of the valve within the patient-specific aortic root, different material properties of the valve, or geometric parameterization of different valve sizes and types. Utilizing the ROM framework allows for significant reductions in computational costs, as evidenced by Table 2, mainly due to the number of degrees of freedom utilized in the reduced problem relative to the FOM. These savings may be particularly practical for simulating TAVR deployment in a clinical environment, since the framework provides the opportunity to use different parameters that provide accurate and computationally less expensive results compared to traditional FE simulations after a single offline phase.

[0074] A ROM framework based on the POD Galerkin approach is introduced and applied towards the structural deformation of a 29mm Medtronic Evolut R valve. By using only 15 probe points and imposing a "force-vs" load on each in the offline phase of the framework, a significant drop in computation time was observed for simulations mimicking the crimping and expansion of the Evolut frame. In addition to the reduction in computational cost, the ROM simulations were solved almost identically to the traditional FE method employed. Further refinements of the framework are underway to rapidly and accurately simulate the TAVR deployment process in its entirety, including addressing limitations such as the use of linear elastic material properties and utilizing more physiologically accurate boundary conditions.

[0075] Computational analysis of hemodynamics after TAVR is also an important point of interest for clinicians. Studies have shown that turbulent flow dynamics are created within the aortic root after THV implantation, as well as flow stagnation within the aortic root sinuses due to patient-specific aortic morphology. To evaluate these flow characteristics, analysis of fluid dynamics in response to THVs via CFD is required. CFD can be used to estimate pressure gradients across native or transcatheter valves as well as provide information on blood flow lines through the valve, all of which provide clinicians with important information on the health of the native valve or the performance of the THV. Combined with the structural mechanics of the valve leaflets, this results in a fluid-structure interaction problem that needs to be solved to provide accurate predictions in patient-specific cases, which dramatically increases the computational costs. ROM can also play an essential role here in reducing the computational costs associated with flow simulation. Coupled with appropriate boundary conditions at the ROM and fluid-solid interface for structural simulation of TAVR deployment, such a combined ROM framework provides clinicians with rapid estimation of pressure gradients, areas of flow stagnation, and pre- and post-procedure flow dynamic information for successful TAVR procedure in individual patients.

[0076] It will be apparent to those skilled in the art that various modifications and variations can be made in the present disclosure without departing from the scope or spirit of the invention. Other aspects of the present disclosure will be apparent to those skilled in the art from consideration of the specification and practice of the methods disclosed herein. It is intended that the specification and examples be considered as exemplary only, with the true scope and spirit of the invention being indicated by the following claims.

[0077] It should be appreciated that the logical operations described above may be implemented as (1) a sequence of computer-implemented operations or program modules executed on a computing system, and / or (2) as interconnected machine logic circuits or circuit modules within a computing system. The implementation is a matter of choice dependent on the performance and other requirements of the computing system. Accordingly, the logical operations described herein are referred to variously as state operations, operations, or modules. These operations, operations, and / or modules may be implemented in software, firmware, special purpose digital logic, hardware, and any combination thereof. It should also be appreciated that more or fewer operations may be performed than illustrated in the figures and described herein. These operations may also be performed in different orders than described herein.

[0078] 23 illustrates an example computer architecture of a computer system 200 capable of executing software components that can use the output of the example methods described herein. The computer architecture illustrated in FIG. 23 illustrates an example computer system configuration in which computer 200 may be utilized to execute any aspect of the components and / or modules presented herein that are described as executing on an analysis system or any components in communication therewith.

[0079] In one aspect, computing device 200 may comprise two or more computers in communication with each other that cooperate to perform a task. For example, but not limited to, an application may be divided in a manner that allows for simultaneous and / or parallel processing of instructions of the application. Alternatively, data processed by an application may be divided in a manner that allows for simultaneous and / or parallel processing of different portions of the data set by two or more computers. In one aspect, virtualization software may be employed by computing device 200 to provide the functionality of multiple servers that are not directly bound to the number of computers in computing device 200. For example, the virtualization software may provide 20 virtual servers on four physical computers. In one aspect, the functionality disclosed above may be provided by running an application and / or multiple applications in a cloud computing environment. Cloud computing may include providing computing services over a network connection using dynamically scalable computing resources. Cloud computing may be supported at least in part by virtualization software. Cloud computing environments may be established by enterprises and / or rented as needed from third party providers. Some cloud computing environments may include cloud computing resources that are owned and operated by the enterprise, as well as cloud computing resources rented and / or leased from third-party providers.

[0080] In its most basic configuration, computing device 200 typically includes at least one processing unit 220 and system memory 230. Depending on the exact configuration and type of computing device, system memory 230 may be volatile (such as random-access memory (RAM)), non-volatile (such as read-only memory (ROM), flash memory, etc.), or some combination of the two.

[0081] This most basic configuration is illustrated in FIG. 23 by dashed line 210. Processing unit 220 may be a standard programmable processor that performs arithmetic and logical operations necessary for the operation of computing device 200. Although one processing unit 220 is shown, there may be multiple processors. As used herein, processing unit and processor refer to physical hardware devices that execute coded instructions to perform functions on inputs and produce outputs, including, for example, but not limited to, microprocessors (MCUs), microcontrollers, graphical processing units (GPUs), and application specific circuits (ASICs). Thus, although instructions may be described as being executed by one processor, the instructions may be executed simultaneously, sequentially, or alternatively by one or more processors. Computing device 200 may also include a bus or other communication mechanism for communicating information between various components of computing device 200.

[0082] Computing device 200 may have additional features / functionality. For example, computing device 200 may include additional storage, such as removable storage 240 and non-removable storage 250, including, but not limited to, magnetic or optical disks or tape. Computing device 200 may also include network connections 280 that enable the device to communicate with other devices, such as via communication paths described herein. Network connection 280 may take the form of a modem, a modem bank, an Ethernet card, a universal serial bus (USB) interface card, a serial interface, a token ring card, a fiber distributed data interface (FDDI) card, a wireless local area network (WLAN) card, a wireless transceiver card, such as a code division multiple access (CDMA), global system for mobile communications (GSM), long-term evolution (LTE), worldwide interoperability for microwave access (WiMAX) and / or other air interface protocol wireless transceiver card, and other well known network devices. Computing device 200 may have input devices 270, such as a keyboard, keypad, switches, dials, a mouse, a track ball, a touch screen, a voice recognition device, a card reader, a paper tape reader, or other well-known input devices.Also included may be output devices 260 such as printers, video monitors, liquid crystal displays (LCDs), touch screen displays, displays, speakers, virtual reality interfaces, etc. Interactive interfaces for real-time user modification of input and output visualization may also be implemented to allow the clinician to explore the outcomes of various surgical options, thereby aiding in decision making. Actual patient imaging, such as x-ray angiograms, may also be blended with real-time simulation results to provide a more user-friendly environment for clinical practice. Additional devices may be connected to the bus to facilitate communication of data between components of the computing device 200. All of these devices are well known in the art and need not be described in detail here.

[0083] The processing unit 220 may be configured to execute program code encoded in a tangible computer-readable medium. A tangible computer-readable medium refers to any medium capable of providing data that causes the computing device 200 (i.e., a machine) to operate in a specific manner. A variety of computer-readable media may be utilized to provide instructions to the processing unit 220 for execution. Exemplary tangible computer-readable media may include, but are not limited to, volatile, non-volatile, removable, and non-removable media implemented in any method or technology for storage of information, such as computer-readable instructions, data structures, program modules, or other data. System memory 230, removable storage 240, and non-removable storage 250 are all examples of tangible computer storage media. Example tangible computer-readable recording media include, but are not limited to, integrated circuits (e.g., field programmable gate arrays, or application specific ICs), hard disks, optical disks, magneto-optical disks, floppy disks, magnetic tape, holographic storage media, solid state devices, RAM, ROM, electrically erasable program read-only memory (EEPROM), flash memory or other memory technologies, CD-ROM, digital versatile disk (DVD) or other optical storage, magnetic cassettes, magnetic tape, magnetic disk storage or other magnetic storage devices.

[0084] In view of the above, it should be appreciated that many types of physical transformations may occur in computer architecture 200 to store and execute the software components presented herein. It should also be appreciated that computer architecture 200 may include other types of computing devices, including handheld computers, embedded computer systems, personal digital assistants, and other types of computing devices known to those of skill in the art. It is also contemplated that computer architecture 200 may not include all of the components shown in FIG. 23, may include other components not explicitly shown in FIG. 23, or may utilize a different architecture than that shown in FIG. 23.

[0085] In the illustrated embodiment, processing unit 220 may execute program code stored in system memory 230. For example, a bus may carry data to system memory 230, from which processing unit 220 receives and executes instructions. Data received by system memory 230 may optionally be stored on removable storage 240 or non-removable storage 250 before or after execution by processing unit 220.

[0086] It is to be understood that the various techniques described herein may be implemented in connection with hardware or software or, where appropriate, a combination thereof. Thus, the methods and apparatus of the presently disclosed subject matter, or certain aspects or portions thereof, may take the form of program code (i.e., instructions) embodied in a tangible medium, such as a floppy diskette, CD-ROM, hard drive, or any other machine-readable storage medium, which when loaded into and executed by a machine, such as a computing device, causes the machine to become an apparatus for practicing the presently disclosed subject matter. In the case of program code execution on a programmable computer, the computing device generally includes a processor, a processor-readable storage medium (including volatile and non-volatile memory and / or storage elements), at least one input device, and at least one output device. One or more programs may perform or utilize the processes described in connection with the presently disclosed subject matter, for example, through application programming interfaces (APIs), reusable controls, or the like. Such programs may be implemented in a high-level procedural or object-oriented programming language to communicate with a computer system. However, the programs may be implemented in assembly or machine language, if desired. In any case, the language may be a compiled or interpreted language, and combined with hardware implementations.

[0087] Furthermore, the various components may be in communication via wireless and / or wired or other desired available communication means, systems, and hardware.

[0088] Additionally, various components and modules may be replaced by other modules or components providing similar functionality.

[0089] The computer architecture 200 includes the necessary software and / or hardware components and modules to enable the functionality of the modeling, simulations and methods disclosed in this disclosure. In some embodiments, the computer architecture 200 may include artificial intelligence (AI) modules or algorithms and / or machine learning (ML) modules or algorithms (e.g., stored in the system memory 230, the removable storage 240, the non-removable storage 250, and / or a cloud database). The AI ​​and / or ML modules / algorithms may enhance the predictive power of the models, simulations, and / or methods disclosed in this disclosure. For example, by using deep learning, AI and / or ML model training, including patient information and any relevant input data to the computational model, the predictive power of the computational model may be significantly improved. The AI ​​and / or MI modules / algorithms also help improve the sensitivity and specificity of predictions as the database grows. In some aspects, the computer architecture 200 may include virtual reality (VR), augmented reality (AR), and / or mixed reality displays, headsets, glasses, or any other suitable display devices as part of the output devices 260 and / or input devices 270. In some aspects, the display devices may be interactive to allow a user to select from options including with or without AR, with or without VR, or fusion with real-time clinical imaging to help the clinician interact and make decisions.

[0090] Although illustrative aspects of the disclosure are described in detail in certain instances herein, it should be understood that other aspects are contemplated. Thus, the disclosure is not intended to be limited in scope to the details of construction and the arrangement of components set forth in the following detailed description or illustrated in the drawings. The disclosure is capable of other aspects and of being practiced or carried out in various ways.

[0091] As used in this specification and the appended claims, the singular forms "a," "an," and "the" include plural referents unless the context clearly dictates otherwise. Ranges may be expressed herein as from "about" or "approximately" one particular value and / or to "about" or "approximately" another particular value. When such a range is expressed, another exemplary embodiment includes from the one particular value and / or to the other particular value.

[0092] "Comprising," "containing," or "including" means that the named compounds, elements, particles, or method steps are present in a composition, article, or method, but do not exclude the presence of other such compounds, materials, particles, or method steps, even if those other compounds, materials, particles, or method steps have the same function as the one named.

[0093] In describing the exemplary embodiments, technical terms are used for the sake of clarity. Each term is intended to have the broadest meaning as understood by a person skilled in the art and to include all technical equivalents that operate in a similar manner to achieve a similar purpose. It should also be understood that the reference to one or more steps of a method does not exclude the presence of additional or intervening method steps between those steps explicitly identified. Method steps may be performed in a different order than described herein without departing from the scope of the present disclosure.

[0094] Similarly, it should be understood that the reference to one or more components in a device or system does not exclude the presence of additional or intervening components between those components that are explicitly identified.

[0095] As used herein, a "subject" may be any applicable human, animal, or other organism, living or dead, or other biological or molecular structure or chemical environment, and may relate to a particular component of the subject, such as a particular tissue or fluid of the subject (e.g., human tissue in a particular area of ​​the body of a living subject), which may be a particular location of the subject, referred to herein as an "area of ​​interest" or "region of interest."

[0096] As described herein, it is to be appreciated that the subject may be a human or any animal. It is to be appreciated that the animal may be of any of a wide variety of applicable types, including, but not limited to, mammals, veterinary animals, livestock animals or pet-type animals, etc. By way of illustration, the animal may be a laboratory animal (e.g., rats, dogs, pigs, monkeys) specifically selected to have certain characteristics similar to humans, etc. It is to be appreciated, for example, that the subject may be any applicable human patient.

[0097] The term "about" as used herein means approximately, in the region of, roughly, or around. When the term "about" is used in conjunction with a numerical range, it modifies the range by extending the boundaries above and below the numerical values ​​set forth. In general, the term "about" is used herein to modify a numerical value above and below the stated value with a variance of 10%. In one embodiment, the term "about" means plus or minus 10% of the numerical value of the number with which it is used. Thus, about 50% means within a range of 45% to 55%. Numerical ranges described herein by endpoints include all numbers and decimals subsumed within that range (e.g., 1 to 5 includes 1, 1.5, 2, 2.75, 3, 3.90, 4, 4.24, and 5).

[0098] Similarly, numerical ranges recited herein by endpoints include the subranges subsumed within that range (e.g., 1 to 5 includes 1 to 1.5, 1.5 to 2, 2 to 2.75, 2.75 to 3, 3 to 3.90, 3.90 to 4, 4 to 4.24, 4.24 to 5, 2 to 5, 3 to 5, 1 to 4, and 2 to 4). It is also to be understood that all numbers and decimals thereof are intended to be modified by the term "about."

Claims

1. obtaining a CT scan of the patient; generating an anatomical model; simulating THV deployment at multiple depths and angles of the THV, incision location or depth for BASILICA and / or LAMPOON, balloon filling volume and pressure, and tissue modification in said anatomical model to determine optimal procedural values ​​for each variable; A patient-specific preoperative model is generated by performing

2. 2. The patient-specific pre-operative model of claim 1, wherein generating the anatomical model includes modeling the aortic root, native aortic or mitral valve, left ventricle, left atrium, calcifications, biological valves or stents, and valve cusps.

3. The patient-specific pre-operative model of claim 1 , wherein the patient has not undergone any previous intervention or alteration of the cardiac anatomy.

4. 10. The patient-specific pre-operative model of claim 1, wherein the anatomical model of the patient comprises a previously implanted stented bioprosthetic heart valve that is in need of fracture and replacement.

5. The patient-specific pre-operative model of claim 4, further comprising measurements of metrics such as coronary flow velocity, transvalve pressure gradients, and how said measurements vary with SHV fracture and / or incision depth, angle, and THV valve sizing for further treatment optimization of transcatheter heart valve simulations inside stented biological or native heart valves with tissue modification.

6. The patient-specific pre-operative model described in claim 4, wherein the THV deployment is performed within the previously implanted stented biological heart valve and the incision is performed on the previously implanted stented biological heart valve.

7. A patient-specific pre-operative model as described in claim 1, wherein the simulated THV deployment is intended to minimize the risk of coronary artery occlusion.

8. The patient-specific pre-operative model of claim 1, wherein the simulated THV deployment is to minimize the risk of left ventricular outflow tract (LVOT) obstruction.

9. A patient-specific pre-operative model as described in claim 1, wherein the simulated THV deployment reduces a pressure gradient.

10. The patient-specific pre-operative model of claim 1, wherein the effect of incision on the LAMPOON is investigated through simulation to optimize hemodynamics.

11. A patient-specific pre-operative model as described in claim 10, wherein the simulation evaluates the pressure gradient across the aortic valve.

12. 1. A method for pre-operatively assessing the success of a transcatheter heart valve replacement procedure in a patient, comprising: obtaining a CT scan of the patient; generating a patient anatomical model; Simulating THV deployment depth, THV angle, balloon volume and pressure in defective surgical heart valves in patients with and without defective surgical heart valve fractures; A method comprising:

13. 13. The method of claim 12, wherein generating the patient anatomy model includes modeling the aortic root, native aortic or mitral valve, left ventricle, left atrium, calcifications, biological valves or stents, and valve cusps.

14. The method described in claim 12, wherein the expansion of the THV is evaluated with and without fracture of the defective surgical heart valve.

15. 1. A method for predictive modeling of deformation of a transcatheter heart valve using reduced modeling, comprising: Obtaining a library of selective nodal solutions of the transcatheter heart valve model using a first set of force boundary conditions using a full order model (FOM); predicting deformation of the transcatheter heart valve under a second set of force boundary conditions for selected nodes via a reduced model, the second set of force boundary conditions being different from the first set of force boundary conditions; A method comprising:

16. 16. The method of claim 15, comprising selecting the selective nodes from nodes that constitute a stent geometry of the transcatheter heart valve.

17. The method of claim 15, wherein the reduced model is constructed from a Singular Value Decomposition (SVD) analysis and a Proper Orthogonal Decomposition (POD) Galerkin approach.

18. The method of claim 15 , wherein the selective nodes include fewer than 20 nodes.

19. 16. The method of claim 15, wherein the deformation of the transcatheter heart valve occurs upon deployment of the transcatheter heart valve into a patient-specific geometry.

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