Predicting procedural outcomes in transcatheter aortic valve implantation: a scoping review of numerical patient-specific simulations

Figures

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  Figure 1. Post-TAVI outcomes prediction through in-silico simulation techniques. Legend: exemplary applications of computational modeling in predicting TAVI complications: (a) paravalvular leak assessment via fluid–structure interaction simulations; (b) contact pressure mapping to evaluate the risk of post-procedural conduction disturbances.

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  Figure 2. PRISMA-ScR flow diagram. Legend: PRISMA 2020 flow diagram for new systematic reviews used for identification, screening and inclusion of reviewed papers.

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  Figure 3. Exemplary CFD-based PVL evaluation. Legend: the model was able to replicate post-operative significant leak. The figure shows two cross-sectional planes that were placed midway through the leak to quantify flow across the defect.

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  Figure 4. Exemplary FEA-based prediction of conduction disturbance risk after TAVI. Legend: representative FEA–derived maps of contact pressure and von Mises stress distribution before and after TAVI implantation. The upper panel shows a case without post-operative permanent pacemaker (PPM) implantation, characterized by peak contact pressures confined to the virtual basal ring and minimal extension into the LVOT. Correspondingly, the von Mises stress gradient between pre- and post-implantation remained low, indicating limited additional mechanical load on the aortic wall. In contrast, the lower panel illustrates a case requiring post-operative PPM, where a markedly higher von Mises stress gradient and broader peak contact pressure distribution extending across the LVOT suggest increased mechanical interaction between the stent frame and the conduction system.

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  Figure 5. FEA-based simulation of post-TAVI aortic rupture risk. Legend: von Mises stress contour plots showing the stresses exerted by the implanted prosthetic valve on the aortic wall, used to assess the potential risk of rupture following TAVI.

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  Figure 6. Validation of FEA implantation simulation using post-operative CT. Legend: the FEA simulation closely matches the post-procedural CT scan, as shown by the overlay, demonstrating the accuracy of the model.

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  Figure 7. Validation of FSI simulations against post-operative clinical imaging data. Legend: left panels show the velocity field on longitudinal and transverse aortic sections for three representative patients, while the right panels display corresponding Doppler tracings for validation purpose.