Key result
Simulated balloon-expandable valves improve hemodynamics and reduce paravalvular gaps, while self-expandable valves lower peak stress.
Why the study?
Postoperative complications of TAVR are related to the type of implanted prosthetic valve, and the underlying mechanism may guide clinical pre-operative planning.
Does a balloon-expandable valve compared to a self-expandable valve improve hemodynamic parameters and reduce paravalvular gaps in a patient-specific TAVR computational model?
Does a balloon-expandable valve compared to a self-expandable valve improve hemodynamic parameters and reduce paravalvular gaps in a patient-specific TAVR computational model?
Numerical simulation suggests balloon-expandable valves may reduce paravalvular leak risk while self-expandable valves may lower stroke risk due to lower aortic stress.
Transcatheter aortic valve replacement (TAVR) is a minimally invasive strategy for the treatment of aortic stenosis. The complex postoperative complications of TAVR were related to the type of implanted prosthetic valve, and the deep mechanism of this relationship may guide the clinical pre-operative planning. This technical brief developed a numerical method of TAVR to compare the outcome difference between balloon-expandable valve and self-expandable valve and predict the postoperative results. A complete patient-specific aortic model was reconstructed. Two prosthetic valves (balloon-expandable valve and self-expandable valve) were introduced to simulate the implantation procedure, and postprocedural function was studied with fluid-structure interaction method, respectively. Results showed similar stress distribution for two valves, but higher peak stress for balloon-expandable valve model. The balloon-expandable valve was associated with a better circular cross section and smaller paravalvular gaps area. Hemodynamic parameters like cardiac output, mean transvalvular pressure difference, and effective orifice area (EOA) of the balloon-expandable valve model were better than those of the self-expandable valve model. Significant outcome difference was found for two prosthetic valves. Balloon-expandable valve may effectively decrease the risk and degree of postoperative paravalvular leak, while self-expandable valve was conducive to lower stroke risk due to lower aortic stress. The numerical TAVR simulation process may become an assistant tool for prosthesis selection in pre-operative planning and postoperative prediction.
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Li et al. (2022) studied aortic stenosis (n=1). Balloon-expandable valve vs. Self-expandable valve was evaluated on Postprocedural function including stress distribution, paravalvular gaps area, and hemodynamic parameters. A numerical simulation showed balloon-expandable valves yielded better hemodynamics and smaller paravalvular gaps, while self-expandable valves had lower peak stress.
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