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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
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.
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.
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