Effect of Right Ventricular Outflow Tract Material Properties on Simulated Transcatheter Pulmonary Placement.

Finite element (FE) simulations emulating transcatheter pulmonary valve (TPV) system deployment in patient-specific right ventricular outflow tracts (RVOT) assume material properties for the RVOT and adjacent tissues. Sensitivity of the deployment to variation in RVOT material properties is unknown. Moreover, the effect of a transannular patch stiffness and location on simulated TPV deployment has not been explored. A sensitivity analysis on the material properties of a patient-specific RVOT during TPV deployment, modeled as an uncoupled HGO material, was conducted using FEBioUncertainSCI. Further, the effects of a transannular patch during TPV deployment were analyzed by considering two patch locations and four patch stiffnesses. Visualization of results and quantification were performed using custom metrics implemented in SlicerHeart and FEBio. Sensitivity analysis revealed that the shear modulus of the ground matrix <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>(</mml:mo> <mml:mi>c</mml:mi> <mml:mo>)</mml:mo></mml:mrow> </mml:math> , fiber modulus <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"> <mml:mrow> <mml:mfenced> <mml:mrow><mml:msub><mml:mi>k</mml:mi> <mml:mn>1</mml:mn></mml:msub> </mml:mrow> </mml:mfenced> </mml:mrow> </mml:math> , and fiber mean orientation angle <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mrow><mml:mo>(</mml:mo> <mml:mi>γ</mml:mi> <mml:mo>)</mml:mo></mml:mrow> </mml:math> had the greatest effect on 95th %ile stress, whereas only <mml:math xmlns:mml="http://www.w3.org/1998/Math/MathML"><mml:mi>c</mml:mi></mml:math> had the greatest effect on 95th %ile Lagrangian strain. First-order sensitivity indices contributed the greatest to the total-order sensitivity indices. Simulations using a transannular patch revealed that peak stress and strain were dependent on patch location. As stiffness of the patch increased, greater stress was observed at the interface connecting the patch to the RVOT, and stress in the patch itself increased while strain decreased. The total enclosed volume by the TPV device remained unchanged across all simulated patch cases. This study highlights that while uncertainties in tissue material properties and patch locations may influence functional outcomes, FE simulations provide a reliable framework for evaluating these outcomes in TPVR.