Analysis of aortic valve prostheses using advanced cardiovascular imaging—a patient-specific reversed translational approach

Abstract

Abstract Rapid-deployment and transcatheter aortic valve replacement (RDAVR and TAVR) are standard treatment options for aortic valve disease. The lack of uniformity in size labelling and potentially adverse hemodynamic effects emphasize the need for an in-depth comparison of available prostheses. State-of-the-art valves (INTUITY Elite, Perceval, SAPIEN 3 Ultra and Evolut PRO+) were implanted into a patient-specific 3D printed aortic phantom with an annulus size recommended for the evaluated valves. The model was incorporated into a flow loop setup. Analysis of hemodynamic parameters was performed using advanced cardiovascular imaging (4D flow MRI and vector (V) flow ultrasound (US)). US revealed systematic differences in flow rates between RDAVR and TAVR prostheses. 4D flow analysis revealed localized regions of elevated WSS heterogeneously distributed without relevant differences between the prostheses. RDAVR prostheses showed higher kinetic energy loss (EL) along the thoracic aorta in small- compared to large-diameter models. EOA estimations ranged from 2.02 to 2.69 cm 2 for RDAVR to 1.71 cm 2 for 23 mm TAVR. Pressure gradients varied strongly between prosthesis types. Blood flow characteristics presented notable differences between the considered prostheses. This interdisciplinary approach provides a foundation for interpreting clinical outcomes after TAVR or RDAVR and potentially reduce the risk of prosthesis-patient mismatch.