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Impact of Aortic Valve Leaflets Calcium Volume and Distribution on Post-TAVR Conduction Abnormalities
Symon Reza1, Brandon Kovarovic1, Danny Bluestein1
1Department of Biomedical Engineering, Stony Brook University, Stony Brook, New York, USA.
Medrxiv : the Preprint Server for Health Sciences
|May 19, 2025
Summary
Aortic leaflet calcium volume and distribution significantly impact cardiac conduction abnormalities after transcatheter aortic valve replacement (TAVR). Specific calcification patterns, especially on the left coronary leaflet, increase the risk of permanent pacemaker implantation.
Area of Science:
- Cardiovascular research
- Biomedical engineering
- Medical device innovation
Background:
- Transcatheter aortic valve replacement (TAVR) is a growing treatment for aortic stenosis, even in low-risk patients.
- Post-TAVR cardiac conduction abnormalities (CCA) and the need for permanent pacemaker implantation (PPI) are significant concerns.
Purpose of the Study:
- To investigate the influence of aortic leaflet calcium volume and distribution on the risk of post-TAVR CCA.
- To understand the mechanical interactions between the TAVR device and cardiac structures based on calcium deposits.
Main Methods:
- Utilized an electromechanically coupled four-chamber beating heart model to simulate TAVR with a self-expandable Evolut® 26 mm device.
- Modeled five virtual patient scenarios with varying calcium volumes and distributions (none, uniform, LCL, RCL, NCL).
- Simulated electrical conduction and coupled it with structural mechanics to assess tissue-device interactions, including stress and contact pressure.
Main Results:
- Increased calcium volume and specific distributions elevated mechanical stress and contact pressure near the atrioventricular node.
- The left coronary leaflet (LCL) model showed the highest stress and contact pressure (13.1 kPa), indicating a higher risk of conduction disruption.
- The non-coronary leaflet (NCL) model exhibited the lowest values (6.42 kPa), suggesting a lower risk.
Conclusions:
- Aortic leaflet calcium characteristics significantly affect mechanical forces and contact dynamics post-TAVR.
- Integrating pre-procedural assessment of leaflet calcium volume and distribution can personalize TAVR risk stratification and enhance patient outcomes.
