Patient-specific computational analysis of TAVI-in-TAVI: assessing the impact of calcified leaflets resection

The durability of transcatheter heart valves remains the main disadvantage of TAVI for treating aortic valve stenosis. One major challenge in TAVI-in-TAVI is the presence of calcified leaflets from the previously implanted valve, which can lead to improper expansion, prosthesis-patient mismatch and coronary obstruction. This study investigates a novel transcatheter leaflet resection device designed to remove the leaflets of the degenerated valve before a TAVI-in-TAVI procedure. Finite element analysis and smoothed particle hydrodynamics simulations were employed to assess the biomechanical and hemodynamic improvements achieved by this approach. The results demonstrated that transcatheter leaflet resection leads to superior valve expansion, reduced eccentricity, and improved hemodynamic performance compared to conventional TAVI-in-TAVI