Ongoing Experience with Patient-Specific Computer Simulation of Transcatheter Aortic Valve Replacement in Bicuspid Aortic Valve

Professor Stephen Brecker

Transcatheter aortic valve replacement (TAVR) is a procedure used to replace an aortic valve that is narrowed, this method avoids the need for open-heart surgery. TAVR is increasingly being used for younger, lower-risk patients with bicuspid aortic valves (BAV). One common issue with TAVR is the development of paravalvular regurgitation (PVR) and major conduction disturbances in the heart. Patient-specific computer simulations are being explored as a means to identify patients at risk for these complications.

A recent study by Professor Stephen Brecker, consultant cardiologist at Mayo Clinic Healthcare in London, and a team of researchers, involved patients with BAV who were being considered for TAVR with a self-expanding transcatheter heart valve (THV). Before the procedure, the patients underwent patient-specific computer simulations. The simulations were reviewed by a medical team and used to inform decisions about surgical or transcatheter approaches, as well as to help with the sizing and positioning of the THV. The study also recorded clinical outcomes.

Over the course of approximately two years, May 2019 to May 2021, 16 patients with BAV were referred for TAVR with a self-expanding THV. Most of these patients had Sievers Type 1 morphology. Two patients were predicted to develop moderate-to-severe PVR with the TAVR procedure, so they underwent successful surgical aortic valve replacement. For the remaining 14 patients, computer simulations were used to optimize THV sizing and positioning to minimize PVR and conduction disturbances. One patient did develop moderate PVR, and this complication had been correctly predicted by the computer simulations. Importantly, no patients required the insertion of a new permanent pacemaker.

The study suggests that patient-specific computer simulation can be a valuable tool for guiding treatment decisions in patients with BAV who are candidates for TAVR. By using computer simulations to optimize THV sizing and positioning, the study observed favourable clinical outcomes, with a reduced incidence of PVR and conduction disturbances. In essence, patient-specific computer simulations appear to help medical teams make more informed decisions when performing TAVR for patients with BAV, ultimately leading to better outcomes and a reduced need for additional interventions such as permanent pacemaker insertion.

Professor Brecker is a highly regarded cardiologist internationally and is a part of the cardiology team at Mayo Clinic Healthcare in London. Our cardiology team tailors care to your needs while working closely with Mayo Clinic's top-ranked team of consultants in the U.S. Mayo Clinic Healthcare experts employ a range of sophisticated cardiac imaging equipment to ensure a full understanding of your condition. On-site diagnostics include cardiac MRI, CT coronary angiogram, echocardiogram, electrocardiogram (ECG) and transoesophageal echocardiogram (TOE).

To learn more about Mayo Clinic Healthcare’s state of the art cardiology services and how to make a referral, call +44 (0) 207 871 2575 or email

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