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Computational Simulation of Transcatheter Aortic Valve Replacement (TAVR)

Tavr Fig1Aortic stenosis (AS) is the most common heart valve disease encountered in the elderly. The aortic valve leaflets become restricted due to excessive calcium buildup. In the past, surgical aortic valve replacement (SAVR) was the gold standard to treat patients with severe AS, which entailed opening the chest and placing the patient on cardiopulmonary bypass. Today, many patients are eligible for a minimally invasive alternative therapy called transcatheter aortic valve replacement (TAVR). In TAVR, an expandable bioprosthetic aortic valve is delivered to the diseased aortic valve via percutaneous access. TAVR has revolutionized the treatment of AS, and the latest PARTNER 3 and Evolut Low Risk trials show strong promise for TAVR as effective therapy for even the lowest risk patients with AS.

However, many questions remain as TAVR becomes increasingly utilized. One unanswered question is TAVR durability, which is believed to be shorter than the surgical bioprosthetic aortic valves given thinner leaflets. Over time, bioprosthetic valve leaflets will degenerate or ‘wear out’ leading to stenosis or insufficiency. Second, the entity of subclinical leaflet thrombosis has been observed in 10-15% of TAVR patients, which may place patients at risk for stroke.

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