Numerical analysis of piled embankments on soft soils

The construction of embankments on soft soils is a common problem. Soft soil cannot sustain external loads without having large deformations. Piled embankments system provides a possible solution for the construction of roads and railways over soft soils. Until now, the system behaviour could only be described by analytical models such as those included in British or German codes. This paper describes research undertaken to investigate the effects of pile embankment construction in soft soils. Experimental results are used to help investigate arching effect developed due to differential settlement between pile and surrounding soft soil. A numerical parametric study was carried out to examine the impact of various soil parameters on the pile-embankment system behaviour. The outcome of the parametric study implemented using numerical analysis has been investigated and discussed throughout this paper. Based on the numerical analysis carried out in this research, it was found that the earth pressure coefficient normalized by the passive earth pressure Kp plotted on a vertical profile at the midpoint between piles can give a good illustration of arching behaviour. The findings presented in this paper can be considered as guides for numerical analysis and design criteria of soil arching for embankments constructed over piles

An orifice shape-based reduced order model of patient-specific mitral valve regurgitation

Mitral valve regurgitation (MR) is one of the most prevalent valvular heart diseases. Its quantitative assessment is challenging but crucial for treatment decisions. Using computational fluid dynamics (CFD), we developed a reduced order model (ROM) describing the relationship between MR flow rates, transvalvular pressure differences, and the size and shape of the regurgitant valve orifice. Due to its low computational cost, this ROM could easily be implemented into clinical workflows to support the assessment of MR. We reconstructed mitral valves of 43 patients from 3D transesophageal echocardiographic images and estimated the 3D anatomic regurgitant orifice areas using a shrink-wrap algorithm. The orifice shapes were quantified with three dimensionless shape parameters. Steady-state CFD simulations in the reconstructed mitral valves were performed to analyse the relationship between the regurgitant orifice geometry and the regurgitant hemodynamics. Based on the results, three ROMs with increasing complexity were defined, all of which revealed very good agreement with CFD results with a mean bias below 3% for the MR flow rate. Classifying orifices into two shape groups and assigning group-specific flow coefficients in the ROM reduced the limit of agreement predicting regurgitant volumes from 9.0 ml to 5.7 ml at a mean regurgitant volume of 57 ml

Clinical Outcomes With a Repositionable Self-Expanding Transcatheter Aortic Valve Prosthesis: The International FORWARD Study

Background Clinical outcomes in large patient populations from real-world clinical practice with a next-generation self-expanding transcatheter aortic valve are lacking. Objectives This study sought to document the clinical and device performance outcomes of transcatheter aortic valve replacement (TAVR) with a next-generation, self-expanding transcatheter heart valve (THV) system in patients with severe symptomatic aortic stenosis (AS) in routine clinical practice. Methods The FORWARD (CoreValve Evolut R FORWARD) study is a prospective, single-arm, multinational, multicenter, observational study. An independent clinical events committee adjudicated safety endpoints based on Valve Academic Research Consortium-2 definitions. An independent echocardiographic core laboratory evaluated all echocardiograms. From January 2016 to December 2016, TAVR with the next-generation self-expanding THV was attempted in 1,038 patients with symptomatic, severe AS at 53 centers on 4 continents. Results Mean age was 81.8 ± 6.2 years, 64.9% were women, the mean Society of Thoracic Surgeons Predicted Risk of Mortality was 5.5 ± 4.5%, and 33.9% of patients were deemed frail. The repositioning feature of the THV was applied in 25.8% of patients. A single valve was implanted in the proper anatomic location in 98.9% of patients. The mean aortic valve gradient was 8.5 ± 5.6 mm Hg, and moderate or severe aortic regurgitation was 1.9% at discharge. All-cause mortality was 1.9%, and disabling stroke occurred in 1.8% at 30 days. The expected-to-observed early surgical mortality ratio was 0.35. A pacemaker was implanted in 17.5% of patients. Conclusions TAVR using the next-generation THV is clinically safe and effective for treating older patients with severe AS at increased operative risk. (CoreValve Evolut R FORWARD Study [FORWARD]; NCT02592369