A Computational Study on Deformed Bioprosthetic Valve Geometries: Clinically Relevant Valve Performance Metrics

Transcatheter aortic valves (TAV) are symmetrically designed, but they are often not deployed inside cylindrical conduits with circular cross-sectional areas. Many TAV patients have heavily calcified aortic valves, which often result in deformed prosthesis geometries after deployment. We investigated the effects of deformed valve annulus configurations on a surgical bioprosthetic valve as a model for TAV. We studied valve leaflet motions, stresses and strains, and analog hydrodynamic measures (using geometric methods), via finite element (FE) modeling. Two categories of annular deformations were created to approximate clinical observations: (1) noncircular annulus with valve area conserved, and (2) under-expansion (reduced area) compared to circular annulus. We found that under-expansion had more impact on increasing stenosis (with geometric orifice area metrics) than noncircularity, and that noncircularity had more impact on increasing regurgitation (with regurgitation orifice area metrics) than under-expansion. We found durability predictors (stress/strain) to be the highest in the commissure regions of noncircular configurations such as EllipMajor (noncircular and under-expansion areas). Other clinically relevant performance aspects such as leaflet kinematics and coaptation were also investigated with the noncircular configurations. This study provides a framework for choosing the most challenging TAV deformations for acute and long-term valve performance in the design and testing phase of device development.