A fast in silico model for preoperative risk assessment of paravalvular leakage.

In silico simulations can be used to evaluate and optimize the safety, quality, efficacy and applicability of medical devices. Furthermore, in silico modeling is a powerful tool in therapy planning to optimally tailor treatment for each patient. For this purpose, a workflow to perform fast preoperative risk assessment of paravalvular leakage (PVL) after transcatheter aortic valve replacement (TAVR) is presented in this paper. To this end, a novel, efficient method is introduced to calculate the regurgitant volume in a simplified, but sufficiently accurate manner. A proof of concept of the method is obtained by comparison of the calculated results with results obtained from in vitro experiments. Furthermore, computational fluid dynamics (CFD) simulations are used to validate more complex stenosis scenarios. Comparing the simplified leakage model to CFD simulations reveals its potential for procedure planning and qualitative preoperative risk assessment of PVL. Finally, a 3D device deployment model and the efficient leakage model are combined to showcase the application of the presented leakage model, by studying the effect of stent size and the degree of stenosis on the regurgitant volume. The presented leakage model is also used to visualize the leakage path. To generalize the leakage model to a wide range of clinical applications, further validation on a large cohort of patients is needed to validate the accuracy of the model's prediction under various patient-specific conditions.

Computational modeling of braided venous stents - Effect of design features and device-tissue interaction on stent performance.

Designing venous stents with desired properties is challenging due to the partly conflicting performance criteria, e.g., enhancing flexibility may be at odds with increasing patency. To evaluate the effect of design parameters on the mechanical performance of braided stents, computational simulations are performed using finite element analysis. Model validation is performed through comparison with measurements. Considered design features are stent length, wire diameter, pick rate, number of wires, and stent end-type, being either open-ended or closed looped. Based on the requirements of venous stents, tests are defined to study the effect of design variations with respect to the following key performance criteria: chronic outward force, crush resistance, conformability, and foreshortening. Computational modeling is demonstrated to be a valuable tool in the design process through its ability of assessing sensitivities of various performance metrics to the design parameters. Additionally, it is shown, using computational modeling, that the interaction between a braided stent and its surrounding anatomy has a significant impact on its performance. Therefore, taking into account device-tissue interaction is crucial for the proper assessment of stent performance.

From Fibrils to Toughness: Multi-Scale Mechanics of Fibrillating Interfaces in Stretchable Electronics.

Metal-elastomer interfacial systems, often encountered in stretchable electronics, demonstrate remarkably high interface fracture toughness values. Evidently, a large gap exists between the rather small adhesion energy levels at the microscopic scale ('intrinsic adhesion') and the large measured macroscopic work-of-separation. This energy gap is closed here by unravelling the underlying dissipative mechanisms through a systematic numerical/experimental multi-scale approach. This self-containing contribution collects and reviews previously published results and addresses the remaining open questions by providing new and independent results obtained from an alternative experimental set-up. In particular, the experimental studies on Cu-PDMS (Poly(dimethylsiloxane)) samples conclusively reveal the essential role of fibrillation mechanisms at the micro-meter scale during the metal-elastomer delamination process. The micro-scale numerical analyses on single and multiple fibrils show that the dynamic release of the stored elastic energy by multiple fibril fracture, including the interaction with the adjacent deforming bulk PDMS and its highly nonlinear behaviour, provide a mechanistic understanding of the high work-of-separation. An experimentally validated quantitative relation between the macroscopic work-of-separation and peel front height is established from the simulation results. Finally, it is shown that a micro-mechanically motivated shape of the traction-separation law in cohesive zone models is essential to describe the delamination process in fibrillating metal-elastomer systems in a physically meaningful way.

Simulation of arterial dissection by a penetrating external body using cohesive zone modelling.

In this paper, we study the dissection of arterial layers by means of a stiff, planar, penetrating external body (a 'wedge'), and formulate a novel model of the process using cohesive zone formalism. The work is motivated by a need for better understanding of, and numerical tools for simulating catheter-induced dissection, which is a potentially catastrophic complication whose mechanisms remain little understood. As well as the large deformations and rupture of the tissue, models of such a process must accurately capture the interaction between the tissue and the external body driving the dissection. The latter feature, in particular, distinguishes catheter-induced dissection from, for example, straightforward peeling, which is relatively well-studied. As a step towards such models, we study a scenario involving a geometrically simpler penetrating object (the wedge), which affords more reliable comparison with experimental observations, but which retains the key feature of dissection driven by an external body, as described. Particular emphasis is placed on assessing the reliability of cohesive zone approaches in this context. A series of wedge-driven dissection experiments on porcine aorta were undertaken, from which tissue elastic and fracture parameters were estimated. Finite element models of the experimental configuration, with tissue considered to be a hyperelastic medium, and evolution of tissue rupture modelled with a consistent large-displacement cohesive formulation, were then constructed. Model-predicted and experimentally measured reaction forces on the wedge throughout the dissection process were compared and found to agree well. The performance of the cohesive formulation in modelling externally driven dissection is finally assessed, and the prospects for numerical models of catheter-induced dissection using such approaches is considered.