Comparison of steady-state and transient flow measurements for the characterization of paravalvular leakage of transcatheter-aortic valve prostheses

Severe aortic valve stenosis has been successfully treated with minimally invasive transcatheter aortic valve replacement (TAVR) for more than 20 years. The therapy is applied to an increasing cohort of patients. Nevertheless, paravalvular leakage (PVL) remains one of the main complications after TAVR implantation reducing safety and efficacy of the implant. To improve TAVR performance, virtual patient cohorts can be used to generate a significant amount of data with biologically varying conditions comparable to clinically realworld data. For this purpose, in silico models need to be established which are used to evaluate the possible occurrence of PVL. When establishing in silico models, the question between simplification to reduce computational effort and still valid information from the model must always be clarified. Thus, we investigated the comparability between steadystate and transient PVL measurements as an input parameter for simulations in virtual cohorts. A clinically established TAVR was implanted into different annulus models and tested in a steady-state back-flow test bench and in a pulse duplicator system. As a result, leakage rates were compared and assumptions for the in silico models were derived. Although the trend of PVL is comparable in steady-state and transient conditions, absolute values differ making it difficult to extract generalized assumptions. Especially when PVL increased, e.g. in a larger implantation diameter or in an imperfect annulus, the variation also increased up to 50% of the measured value.