Patient-specific numerical model of calcific aortic stenosis and its treatment by balloon-expandable transcatheter aortic valve: Effect of positioning on the anchorage

Despite the promising outcomes of transcatheter aortic valve replacement (TAVR), adverse events may occur as a result of suboptimal placement. The aim of this study is to evaluate the effect of various TAVR deployment positions on the risk for intra-procedural migration and of post-procedural paravalvular regurgitation. Finite Element (FE) and Computational Fluid Dynamics (CFD) models are presented for several procedural scenarios for a patient-specific morphology. Crimping and deployment of balloon-expandable Edwards SAPIEN were modeled in three locations. The proximal deployment resulted in higher risk for migration, while the distal and midway positioning resulted in comparable outcomes. These resulting configurations were used to assess diastolic hemodynamics. The distal case had preferred hemodynamics compared to the midway with more limited leakage. The proposed approach has the potential to be used in procedural planning to ultimately achieve better clinical outcomes.