Effect of Native Aortic Leaflet Geometry Modification on Transcatheter Aortic Valve Neo-sinus and Aortic Sinus Flow:...

Area of Science:

• Cardiovascular research
• Biomedical engineering
• Medical device innovation

Background:

• Leaflet thrombosis is a serious complication following transcatheter aortic valve replacement (TAVR).
• Blood flow stagnation in the neo-sinus and aortic sinus regions is linked to increased thrombus severity.
• Native aortic leaflet modification is a potential strategy to improve hemodynamics but lacks extensive data.

Purpose of the Study:

• To evaluate the impact of aortic leaflet geometry modification on flow stagnation in the neo-sinus and aortic sinus regions after simulated TAVR.
• To investigate how different leaflet splay geometries affect fluid dynamics in critical post-TAVR areas.

Main Methods:

• Particle image velocimetry was used to measure flow dynamics under varying cardiac outputs (5 LPM and 2.5 LPM).
• Simulations included an intact leaflet (control) and three modified leaflet geometries with increasing splay distances (5 mm, 10 mm, 20 mm).

Main Results:

• Leaflet geometry modification improved flow communication between neo-sinus and aortic sinus regions compared to the control.
• Flow stagnation in the aortic sinus was reduced by over 64% (5 LPM) and 36% (2.5 LPM) across all modified geometries.
• Neo-sinus flow stagnation reduction was observed only with medium (10 mm) and wide (20 mm) splay geometries.

Conclusions:

• Aortic leaflet geometry modification, specifically with at least 10 mm of leaflet splay, can significantly reduce flow stasis.
• These modifications show potential for decreasing the risk of valve thrombosis after TAVR.