2025/01/01 by B. Grossi, Giulia Luraghi, Sara Barati +7 · 1 voice
Medicine · #Aortic Disease and Treatment Approaches #Cardiac Valve Diseases and Treatments #Cardiovascular Function and Risk Factors
paper · doi:10.1093/ehjimp/qyaf018
openalex publication_date 2025/01/01 · openalex created_date 2025/02/07 · openalex updated_date 2026/07/29
Abstract Aims Bicuspid aortic valve (BAV) represents a challenge for transcatheter aortic valve implantation (TAVI). Few data are reported about the procedural implications of BAV using different self-expandable devices. The aim of this study is to investigate how BAV and tricuspid aortic valve (TAV) morphologies influence device selection and their impact on the potential development of post-operative conduction disturbances, using a novel in silico approach. Methods and results Five patients with BAV undergoing TAVI were enrolled. TAVs were virtually modelled within each BAV patient-specific anatomy, resulting in 10 virtual patients. Acurate Neo2 and Evolut R implantations were subsequently simulated across all cases. Post-implantation stresses exerted on both the stent and aortic root were measured, allowing a comparative analysis of the impact of the two valve morphologies. Comparing stent stresses between BAV and TAV configurations, the stress gap increased by 21.96 ± 5.35% (P = 0.01) in Acurate Neo2 cases (n = 6) compared with Evolut R cases (n = 4). The analysis of aortic root stresses showed no significant differences between BAV (n = 5) and TAV (n = 5) configurations, with a mean stress difference of 5.1 ± 8.17% (P > 0.05). Conclusion Our patient-specific model shows that high radial force devices, such as Evolut R, demonstrate consistent expansion regardless of valve morphology, without increasing the risk of post-implantation conduction disturbances, hence resulting more suitable for BAV cases. Incorporating this methodology into pre-operative planning could support clinicians in selecting the most suitable device with a patient-specific approach.