Bicuspid aortic valve (BAV), the most common congenital valvular abnormality, generates asymmetric flow patterns and increased stresses on the leaflets that expedite valvular calcification and structural degeneration. Recently adapted for use in BAV patients, TAVR demonstrates promising performance, but post-TAVR complications tend to get exacerbated due to BAV anatomical complexities. Utilizing patient-specific computational modeling, we address some of these complications. The degree and location of post-TAVR PVL was assessed, and the risk of flow-induced thrombogenicity was analyzed in 3 BAV patients — using older generation TAVR devices that were implanted in these patients, and compared them to the performance of the newest generation TAVR devices using in silico patient models. Significant decrease in PVL and thrombogenic potential was observed after implantation of the newest generation device. The current work demonstrates the potential of using simulations in pre-procedural planning to assess post-TAVR complications, and compare the performance of different devices to achieve better clinical outcomes.

Graphical abstract

Patient-specific computational framework to assess post-transcatheter bicuspid aortic valve replacement paravalvular leakage and flow-induced thrombogenic complications and compare device performances.

中文翻译：

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使用特定于患者的计算模型评估经导管二叶式主动脉瓣置换术中的瓣周漏严重程度和血栓形成可能性

二叶式主动脉瓣 (BAV) 是最常见的先天性瓣膜异常，会产生不对称的血流模式并增加小叶的应力，从而加速瓣膜钙化和结构退化。TAVR 最近适用于 BAV 患者，表现出良好的性能，但由于 BAV 解剖结构的复杂性，TAVR 后并发症往往会加剧。利用针对患者的计算模型，我们解决了其中一些并发症。评估了 TAVR 后 PVL 的程度和位置，并分析了 3 名 BAV 患者的血流诱发血栓形成风险 - 使用植入这些患者的老一代 TAVR 设备，并将其与最新一代 TAVR 的性能进行比较使用计算机患者模型的设备。植入最新一代装置后，观察到 PVL 和血栓形成潜力显着下降。目前的工作证明了在术前计划中使用模拟来评估 TAVR 后并发症的潜力，并比较不同设备的性能以获得更好的临床结果。

图形概要

患者特定的计算框架，用于评估经导管二尖瓣主动脉瓣置换术后瓣周漏和血流引起的血栓形成并发症并比较设备性能。