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Related Concept Videos

Aortic Regurgitation III: Medical Management01:25

Aortic Regurgitation III: Medical Management

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Aortic regurgitation (AR) is when the aortic valve does not close or seal properly, leading to backward blood circulation from the aorta into the left ventricle during diastole. Common causes of AR include rheumatic heart disease, congenital valve defects, and aortic root dilation. Managing AR requires a multifaceted approach to alleviate symptoms, preserve left ventricular function, and address the underlying cause of the regurgitation. Patients with symptomatic AR or significant left...
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Aortic Regurgitation I: Introduction01:15

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IntroductionAortic regurgitation is characterized by the backward flow of blood from the aorta into the left ventricle during diastole and arises from the improper closure of the aortic valve. This condition results in left ventricular volume overload and can stem from both acute and chronic etiologies, each contributing uniquely to the disease's progression and symptomatology.Acute and Chronic CausesAcute aortic regurgitation often results from events that suddenly impair the integrity of the...
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Procedural Strategies for Optimal Transcatheter Aortic Valve Replacement: An International Position Statement.

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Real-World Outcomes of Dedicated Leaflet Modification for Bioprosthetic Valve-In-Valve TAVR: A 150-Patient Commercial Experience.

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Updated: Jan 10, 2026

Biaxial Mechanical Characterizations of Atrioventricular Heart Valves
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Mechanics Post-TAVR for Trileaflet vs Bicuspid Aortic Valves: Insights from Computational Simulation.

Breandan B Yeats1, Aniket Venkatesh1, Sri Krishna Sivakumar1

  • 1Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.

JACC. Advances
|November 20, 2025
PubMed
Summary

Transcatheter aortic valve replacement (TAVR) in patients with bicuspid aortic valve (BAV) shows worse simulated mechanical outcomes compared to trileaflet valves. High calcium volume in BAV patients further impacts these TAVR results.

Keywords:
bicuspid aortic valvecalcific aortic valve diseasecomputational modelingtranscatheter aortic valve replacement

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Area of Science:

  • Cardiovascular Medicine
  • Biomedical Engineering
  • Congenital Heart Defects

Background:

  • Bicuspid aortic valve (BAV) disease is the most prevalent congenital heart defect, characterized by elliptical valve openings and increased calcification.
  • Limited data exist on the long-term effectiveness of transcatheter aortic valve replacement (TAVR) specifically for BAV patients.

Purpose of the Study:

  • To compare simulated post-TAVR mechanical performance between patients with BAV and those with a trileaflet aortic valve (TAV).
  • To evaluate key mechanical metrics, including stent expansion, leaflet stress, and orifice area, in simulated TAVR procedures for both BAV and TAV anatomies.

Main Methods:

  • Utilized pre-TAVR computed tomography scans from trileaflet (n=22) and BAV (n=25) patients to segment aortic valves.
  • Simulated balloon-expandable stent deployment and subsequent physiological pressure application on bioprosthetic leaflets.
  • Measured stent waist expansion ratio, aspect ratio (AR), normalized geometric orifice area (GOA), and maximum leaflet diastolic stress.

Main Results:

  • BAV patients exhibited significantly lower waist expansion ratio (87.8% vs 89.4%), lower waist AR (94.6% vs 98.2%), and lower normalized GOA (88.9% vs 89.5%) compared to trileaflet patients.
  • BAV patients experienced higher maximum leaflet diastolic stress (2.81 MPa vs 2.29 MPa) post-simulated TAVR.
  • In BAV patients, higher calcium volume strongly correlated with worse waist AR (r=-0.75), normalized GOA (r=-0.68), and increased maximum stress (r=0.66).

Conclusions:

  • Simulated TAVR using balloon-expandable valves in BAV patients results in inferior mechanical performance compared to trileaflet aortic valve patients.
  • The presence of high calcium volume in BAV anatomy is a significant factor associated with poorer simulated mechanical outcomes after TAVR.