Key result
Including coronary outlets in TAVI models increases native sinus velocity ~2.3-fold and improves particle clearance.
Why the study?
Existing in vitro and numerical studies lack consensus on whether and how coronary arteries should be incorporated in hemodynamic assessments after TAVI.
Does the inclusion of coronary artery outlets affect the in vitro hemodynamic flow features within the native and neo-sinus following transcatheter aortic valve implantation?
Does the inclusion of coronary artery outlets affect the in vitro hemodynamic flow features within the native and neo-sinus following transcatheter aortic valve implantation?
Absolute Event Rate: 1.34% vs 0.58%
In vitro modeling demonstrates that including coronary artery outlets is crucial when simulating post-TAVI hemodynamics, as their absence substantially underestimates sinus flow velocity and particle washout.
Existing in vitro and numerical studies lack consensus regarding whether and how coronary arteries should be incorporated. This study aims to systematically investigate the effects of coronary artery outlets on the hemodynamic environment within the native sinus and neo-sinus after transcatheter aortic valve implantation (TAVI). Three idealized aortic root models (without coronaries, single coronary, and bilateral coronaries) were fabricated. A VENUS self-expanding valve was implanted at five depths (0 mm, ± 5 mm and ± 10 mm). A pulsatile in vitro flow platform combined with particle image velocimetry (PIV) was applied to quantify velocity fields, vorticity, and particle washout. Correlations between implantation depth and hemodynamic parameters were further assessed. In control models, mean native sinus velocity without coronaries was 0.58 ± 0.49 cm/s and decreased further after TAVI. Introducing a single coronary increased mean velocity to 1.34 ± 0.95 cm/s and generated high-velocity jets (> 10 cm/s) near the ostium; bilateral coronaries produced comparable effects. Vorticity decreased in all post-TAVI configurations. Particle washout analysis demonstrated pronounced stasis without coronary flow but markedly improved clearance when coronary inflow was present. With coronary flow, particle washout was markedly enhanced compared with the no-coronary condition, but did not vary monotonically with implantation depth; instead, it appeared to be governed by the combined effects of local flow environment. Under the present conditions, coronary flow substantially increased velocity magnitude, vorticity, and particle washout within the corresponding native sinus and neo-sinus after self-expanding valve implantation. Neglecting coronary outlets may lead to a substantial underestimation of sinus flow velocity and washout. However, when evaluating the hemodynamics of an individual coronary sinus, inclusion of its corresponding coronary artery alone is likely to be sufficient to capture the essential flow characteristics.
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Wei et al. (2026) studied Transcatheter aortic valve implantation (TAVI) hemodynamics. Inclusion of coronary artery outlets vs. Models without coronary artery outlets was evaluated on Mean native sinus velocity (cm/s). Including coronary outlets in TAVI models increased mean native sinus velocity from 0.58 cm/s to 1.34 cm/s and markedly improved particle clearance compared to models without coronaries.
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