Leaflet Modification for Redo-TAVR: Impact of Valve Type, Expansion, and Failure Mode-A Bench Study

Area of Science:

• Cardiovascular interventions
• Structural heart disease
• Transcatheter aortic valve replacement

Background:

• Leaflet modification (LM) techniques are crucial for redo transcatheter aortic valve replacement (TAVR).
• Understanding factors influencing LM efficacy is essential for improving patient outcomes.
• Current knowledge on LM efficacy determinants in redo TAVR is limited.

Purpose of the Study:

• To investigate the impact of valve constraint, redo-TAVR sizing, flow dynamics, and valve pathology on LM efficacy.
• To analyze how different leaflet modification techniques (BASILICA, BA-BASILICA, balloon laceration) perform under various conditions.
• To quantify the effects on splay area, functional splay area, and splay geometry variability.

Main Methods:

• Evaluated naive and degenerated transcatheter heart valves (THVs) using BASILICA, BA-BASILICA, and balloon laceration techniques.
• Simulated varying annular constraint, pulsatile vs. continuous flow, leaflet modification patterns, second THV oversizing, and index THV degeneration.
• Quantified outcomes including splay area, functional splay area, and variability in splay geometry.

Main Results:

• BASILICA created splay in most valves, improved by BA-BASILICA; annular constraint reduced splay, especially in Evolut valves.
• Flow conditions introduced variability in leaflet splay; balloon laceration yielded unpredictable patterns.
• Second THV oversizing increased splay area, while leaflet degeneration (fibrosis, calcification) diminished functional splay and created irregular cuts.

Conclusions:

• Leaflet splay in redo TAVR is significantly influenced by THV type and constraint.
• Implantation technique, laceration pattern, and the degree of index THV degeneration are critical factors affecting LM efficacy.
• Optimizing LM requires careful consideration of these variables for successful redo TAVR procedures.