Valvular & structural heart disease
Mechanics Post-TAVR for Trileaflet vs Bicuspid Aortic Valves: Insights from Computational Simulation
Authors' conclusion
Balloon-expandable TAVR for BAV has worse simulated mechanical metrics compared to TAVR for trileaflet aortic valve patients and is associated with high calcium volume.
Study context
- Population
- Patients with calcific AS, pre-TAVR CT scans
- Participants
- 25 vs 22
- Comparison
- Bicuspid aortic valve (BAV) vs trileaflet aortic valve, simulated balloon-expandable transcatheter aortic valve replacement (TAVR)
- BAVn = 25
- Trileafletn = 22reference
- Outcome
- Simulated post-TAVR mechanical metrics: stent waist expansion ratio, waist AR, normalized leaflet GOA, maximum leaflet diastolic stress
Main finding
As reported in the abstract
| Group | Waist expansion ratio | Waist aspect ratio (AR) | Normalized geometric orifice area (GOA) | Maximum stress |
|---|---|---|---|---|
| BAV | 87.8% ± 2.6% | 94.6% ± 2.8% | 88.9% ± 0.8% | 2.81 ± 0.44 MPa |
| Trileaflet | 89.4% ± 1.4% | 98.2% ± 1.0% | 89.5% ± 0.7% | 2.29 ± 0.25 MPa |
Waist expansion ratio
BAV87.8% ± 2.6%
Trileaflet89.4% ± 1.4%
Waist aspect ratio (AR)
BAV94.6% ± 2.8%
Trileaflet98.2% ± 1.0%
Normalized geometric orifice area (GOA)
BAV88.9% ± 0.8%
Trileaflet89.5% ± 0.7%
Maximum stress
BAV2.81 ± 0.44 MPa
Trileaflet2.29 ± 0.25 MPa
- BAV vs Trileaflet: P < 0.001 — waist expansion ratio, lower in BAV
- BAV vs Trileaflet: P < 0.001 — waist AR, lower in BAV
- BAV vs Trileaflet: P < 0.01 — normalized GOA, lower in BAV
- BAV vs Trileaflet: P < 0.001 — maximum stress, higher in BAV
Further findings
Correlation of calcium volume with mechanical metrics (BAV)
- Waist AR
- r = −0.75, P < 0.001
- Normalized GOA
- r = −0.68, P < 0.001
- Maximum stress
- r = 0.66, P < 0.001
Original publication
Mechanics Post-TAVR for Trileaflet vs Bicuspid Aortic Valves: Insights from Computational Simulation. JACC Adv. Published 19 November 2025. doi:10.
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