Computational Analysis of Self-Expanding and Balloon-Expandable Transcatheter Heart Valves

Bicuspid aortic valve (BAV) patients are usually excluded from transcatheter aortic valve implantation (TAVI) as this valve anatomy likely leads to oval expansion. This study presents a numerical study of TAVI using both self-expanding and balloon expandable transcatheter heart valve (THV) in bicuspid patients with severe stenosis. The simulation framework included a patient-specific anatomy of the aortic root, calcifications and BAV leaflets extracted from medical imaging analysis as well as a realistic crimping and deployment of the THV. Tissue stress analysis highlighted local maxima in the contact area between the inner aortic lumen and the THV stent frame. Flow analysis based on the smoothed particle hydrodynamics (SPH) technique displayed the area at risk of paravalvular leakage (PVL). These findings provide insights on the TAVI in BAV and thus represents a further step towards the use of in-silico for the virtual planning of TAVI, aiming at improving not only the efficacy of the implantation but also the exploration of borderline anatomy as the case of TAVI in BAVs.