Biomechanical modeling of transcatheter aortic valve replacement in a stenotic bicuspid aortic valve: deployments and paravalvular leakage

Karin Lavon, Gil Marom, Matteo Bianchi, Rotem Halevi, Ashraf Hamdan, Adi Morany, Ehud Raanani, Danny Bluestein, Rami Haj-Ali

Research output: Contribution to journalArticlepeer-review

Abstract

Calcific aortic valve disease (CAVD) is characterized by stiffened aortic valve leaflets. Bicuspid aortic valve (BAV) is the most common congenital heart disease. Transcatheter aortic valve replacement (TAVR) is a treatment approach for CAVD where a stent with mounted bioprosthetic valve is deployed on the stenotic valve. Performing TAVR in calcified BAV patients may be associated with post-procedural complications due to the BAV asymmetrical structure. This study aims to develop refined computational models simulating the deployments of Evolut R and PRO TAVR devices in a representative calcified BAV. The paravalvular leakage (PVL) was also calculated by computational fluid dynamics simulations. Computed tomography scan of severely stenotic BAV patient was acquired. The 3D calcium deposits were generated and embedded inside a parametric model of the BAV. Deployments of the Evolut R and PRO inside the calcified BAV were simulated in five bioprosthesis leaflet orientations. The hypothesis of asymmetric and elliptic stent deployment was confirmed. Positioning the bioprosthesis commissures aligned with the native commissures yielded the lowest PVL (15.7 vs. 29.5 mL/beat). The Evolut PRO reduced the PVL in half compared with the Evolut R (15.7 vs. 28.7 mL/beat). The proposed biomechanical computational model could optimize future TAVR treatment in BAV patients.

Original languageEnglish
Pages (from-to)2129-2143
Number of pages15
JournalMedical and Biological Engineering and Computing
Volume57
Issue number10
DOIs
StatePublished - 1 Oct 2019

Keywords

  • Bicuspid aortic valve
  • Computational fluid dynamics
  • Finite element
  • Paravalvular leakage
  • Transcatheter aortic valve replacement

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