A feasibility study of leaflets configuration adaptive to annular growth in pediatric aortic valve reconstruction

Aortic valve reconstruction preserves the native aortic annulus and permits its physiological growth, offering a superior alternative to prosthetic valve replacement for pediatric patients. However, following aortic valve reconstruction, leaflet adaptation to annular growth remains poorly understood, and current clinical leaflet configurations may have some growth adaptation limitations in children. This study utilized numerical simulations and in-vitro experiments to model annular expansion after aortic valve reconstruction. We investigated the stress distribution and hemodynamic performance of clinical leaflet configurations during annular dilation and designed a refined leaflet configuration for pediatric patients and conducted a feasibility study on it. Results demonstrated that clinical leaflets-characterized by excessive height and reduced width-developed elevated stress concentrations within the belly region during annular growth. It led to valve incompetence, increasing the regurgitation fraction by 4.61 % (p < 0.001). The refined leaflets, featuring increased width and reduced redundant basal tissue, exhibited lower belly region stress. Following annular expansion, refined valves' regurgitation rate increased minimally (1.03 %, p = 0.011) and there was no valvular incompetence. In summary, leaflet configuration affects the hemodynamic performance of the reconstructed valve during aortic annular growth. Refined valves exhibited enhanced adaptive capacity to annular growth, providing an optimized direction for leaflet design in pediatric aortic valve reconstruction surgery.