Radial force and expansion behavior of an elliptical transcatheter aortic valve replacement in a bicuspid aortic valve

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Abstract Transcatheter Aortic Valve Replacement (TAVR) is a widely used treatment for severe aortic stenosis, particularly in patients with a high surgical risk. Although initially designed for tricuspid aortic valves (TAV), its use in bicuspid aortic valves (BAV) presents unique challenges due to anatomical variations and extensive calcifications, which can hinder optimal stent expansion. In this study, a prototype of an elliptical TAVR stent was produced. Radial force measurements were carried out to calibrate the simulation model. In addition, the deployment behaviour of this elliptical TAVR stent was investigated in a patientspecific bicuspid aortic valve geometry with severe calcification. Finite Element (FE) simulations were conducted to analyze the crimping and expansion process of an elliptical TAVR stent. Expansion behavior and radial force behavior were compared with a conventional circular stent design. The simulation results demonstrate that both stents exhibit elliptical deformation due to calcification-induced constraints. However, the elliptical stent experiences less deformation in the narrowest regions, potentially reducing leaflet stress and improving valve function. The elliptical design may enhance the longterm durability of the artificial valve. The findings highlight the potential benefits of elliptical TAVR stents for bicuspid anatomies. Further investigations, including large-scale in silico studies are necessary to optimize stent design and improve clinical outcomes for bicuspid valve patients.

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