Computational methods for the aortic heart valve and its replacements

INTRODUCTION: Replacement with a prosthetic device remains a major treatment option for the patients suffering from heart valve disease, with prevalence growing resulting from an ageing population. While the most popular replacement heart valve continues to be the bioprosthetic heart valve (BHV), its durability remains limited. There is thus a continued need to develop a general understanding of the underlying mechanisms limiting BHV durability to facilitate development of a more durable prosthesis. In this regard, computational models can play a pivotal role as they can evaluate our understanding of the underlying mechanisms and be used to optimize designs that may not always be intuitive. Areas covered: This review covers recent progress in computational models for the simulation of BHV, with a focus on aortic valve (AV) replacement. Recent contributions in valve geometry, leaflet material models, novel methods for numerical simulation, and applications to BHV optimization are discussed. This information should serve not only to infer reliable and dependable BHV function, but also to establish guidelines and insight for the design of future prosthetic valves by analyzing the influence of design, hemodynamics and tissue mechanics. Expert commentary: The paradigm of predictive modeling of heart valve prosthesis are becoming a reality which can simultaneously improve clinical outcomes and reduce costs. It can also lead to patient-specific valve design.