Modeling Aortic Valvular Leaflet Thrombosis Risk Following Transcatheter Aortic Valve Replacement

Abstract

Calcific aortic stenosis (AS) is the thickening of the aortic valve leaflets in the heart due to calcium buildup. Currently, the most widespread treatment option is transcatheter aortic valve replacement (TAVR), a minimally invasive interventional procedure where a prosthetic valve is delivered to replace the diseased one. Despite TAVR’s effectiveness in treating AS, there have been reported instances of leaflet thrombosis (LT), which is characterized by the formation of blood clots around a leaflet of a prosthetic valve. Therefore, this study aimed to predict the risk of LT following different, controllable prosthetic valve deployment orientations through computational simulations. Normalized circulation, a quantity found to be inversely related to expected thrombus volume, was calculated following each deployment orientation and it was determined that different prosthetic valve commissural alignments may lead to higher NCs and lower risk of LT, but neither different stent rotational orientations nor different stent expansion volumes had a significant effect on NCs, and therefore risk of LT development. Additionally assessment of blood flow profiles post-TAVR deployments demonstrated that the maximum blood speed reached and the maximum pressure drop through the aortic valve were both decreased towards their respective healthy ranges.