Abstract
Transcatheter aortic valve replacement (TAVR) has become a milestone for the management of aortic stenosis in a growing number of patients who are unfavorable candidates for surgery. With the new generation of transcatheter heart valves (THV), the feasibility of transcatheter mitral valve replacement (TMVR) for degenerated mitral bioprostheses and failed annuloplasty rings has been demonstrated. In this setting, computational simulations are modernizing the preoperative planning of transcatheter heart valve interventions by predicting the outcome of the bioprosthesis interaction with the human host in a patient-specific fashion. However, computational modeling needs to carry out increasingly challenging levels including the verification and validation to obtain accurate and realistic predictions. This review aims to provide an overall assessment of the recent advances in computational modeling for TAVR and TMVR as well as gaps in the knowledge limiting model credibility and reliability.
Highlights
Transcatheter valve interventions have transformed the management of valvular heart diseases as the outcome of patients with bioprosthetic devices is as favorable as that observed with porcine and mechanical heart valves
This device–host interaction has a fundamental role on the performance of transcatheter heart valves (THV), since the native valve leaflets are not excised in transcatheter therapies
Maladapting the THV device to the patient anatomy may lead to several acute complications such as paravalvular leakage, coronary obstruction in transcatheter aortic valve replacement (TAVR), as well as device protrusion in the left ventricle and annulus rupture in the transcatheter mitral valve replacement (TMVR)
Summary
Transcatheter valve interventions have transformed the management of valvular heart diseases as the outcome of patients with bioprosthetic devices is as favorable as that observed with porcine and mechanical heart valves. Maladapting the THV device to the patient anatomy may lead to several acute complications such as paravalvular leakage, coronary obstruction in transcatheter aortic valve replacement (TAVR), as well as device protrusion in the left ventricle (namely, LVOT obstruction) and annulus rupture in the transcatheter mitral valve replacement (TMVR) These potential complications represent a clinical problem and are associated with impaired prognosis according to the patient baseline risk. Individuals between 60 and 75 years of age, who have been only rarely included in TAVR trials, can be defined as “young” AS patients according to specific clinical characteristics In this patient group, valve durability remains the major concern on the long-term clinical outcome with the hazard of multiple replacement procedures with aging. Severe AS on the bicuspid aortic valve is considered another patient group usually excluded by many clinical trials because of the risk of device elliptical expansion in the bicuspid annulus [3]
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