Association of Implantation Depth With Hemodynamics and Mechanical Consequences in Small Valve-In-Valve TAVR.
7 affiliations
- 1Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China.
- 2Clinical School of Thoracic, Tianjin Medical University, Tianjin, China.
- 3Department of Radiology, Chest Hospital, Tianjin University, Tianjin, China.
- 4College of Biomedical Engineering, Fudan University, Shanghai, China.
- 5Department of Occupational and Environmental Health, School of Public Health, Tianjin Medical University, Tianjin, China; Key Laboratory of Prevention and Control of Major Diseases in the Population, Ministry of Education, Tianjin Medical University, Tianjin, China.
- 6Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China. Electronic address: [email protected].
- 7Department of Cardiovascular Surgery, Chest Hospital, Tianjin University, Tianjin, China. Electronic address: [email protected].
Abstract
Background
Valve-in-valve (ViV) transcatheter aortic valve replacement in small surgical bioprostheses is often limited by residual gradients and prosthesis-patient mismatch. Implantation depth is operator-controlled, but depth guidance for different valve combinations remains limited.Objectives
The authors aimed to evaluate the effects of implantation depth on ViV hemodynamics, leaflet deformation, and pinwheeling in small surgical bioprostheses and to assess the mechanical consequences of THV underexpansion using accelerated wear testing.Methods
A 21-mm self-expanding transcatheter heart valve was implanted in five 21-mm surgical heart valves at multiple depths in a pulse duplicator. Mean gradient, effective orifice area, regurgitation volume, energy loss, leaflet deformation, and pinwheeling were assessed. Selected constrained ViV configurations underwent 200 million cycles of accelerated wear testing under ISO 5840 conditions.Results
Implantation depth substantially influenced ViV performance. In 3 porcine surgical valves, the most favorable combined hemodynamic profile occurred within a moderate-to-deep depth window of approximately 13.0 to 14.5 mm, although the optimal value differed across individual hemodynamic and deformation endpoints. Excessive depth increased frame constraint, leaflet distortion, and pinwheeling. Two bovine surgical valves showed mixed or U-shaped responses, consistent with differences in true internal diameter and transcatheter valve oversizing. The selected ViV configurations completed 200 million accelerated wear cycles without gross structural failure under bench conditions.Conclusions
In small ViV-transcatheter aortic valve replacement, the hemodynamic effects of implantation depth are valve-combination specific. A depth-window strategy may improve acute hydrodynamic performance, but clinical translation requires balancing hemodynamic benefit against leaflet deformation and durability-related uncertainty.
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BibTeX
@article{fu2026association,
title = {{Association of Implantation Depth With Hemodynamics and Mechanical Consequences in Small Valve-In-Valve TAVR.}},
author = {Bo Fu and Fenlong Xue and Yanhe Ma and Zhengda Chen and Shihong Liu and Hongyue Sun and Zhigang Guo and Qingliang Chen and Nan Jiang},
journal = {JACC. Asia},
year = {2026},
month = oct,
doi = {10.1016/j.jacasi.2026.07.050},
url = {https://europepmc.org/article/MED/42841565},
note = {CC BY},
}
RIS
TY - JOUR
TI - Association of Implantation Depth With Hemodynamics and Mechanical Consequences in Small Valve-In-Valve TAVR.
AU - Bo Fu
AU - Fenlong Xue
AU - Yanhe Ma
AU - Zhengda Chen
AU - Shihong Liu
AU - Hongyue Sun
AU - Zhigang Guo
AU - Qingliang Chen
AU - Nan Jiang
PY - 2026
DA - 2026/10/01
JO - JACC. Asia
DO - 10.1016/j.jacasi.2026.07.050
UR - https://europepmc.org/article/MED/42841565
AB - Background Valve-in-valve (ViV) transcatheter aortic valve replacement in small surgical bioprostheses is often limited by residual gradients and prosthesis-patient mismatch. Implantation depth is operator-controlled, but depth guidance for different valve combinations remains limited.Objectives The authors aimed to evaluate the effects of implantation depth on ViV hemodynamics, leaflet deformation, and pinwheeling in small surgical bioprostheses and to assess the mechanical consequences of THV underexpansion using accelerated wear testing.Methods A 21-mm self-expanding transcatheter heart valve was implanted in five 21-mm surgical heart valves at multiple depths in a pulse duplicator. Mean gradient, effective orifice area, regurgitation volume, energy loss, leaflet deformation, and pinwheeling were assessed. Selected constrained ViV configurations underwent 200 million cycles of accelerated wear testing under ISO 5840 conditions.Results Implantation depth substantially influenced ViV performance. In 3 porcine surgical valves, the most favorable combined hemodynamic profile occurred within a moderate-to-deep depth window of approximately 13.0 to 14.5 mm, although the optimal value differed across individual hemodynamic and deformation endpoints. Excessive depth increased frame constraint, leaflet distortion, and pinwheeling. Two bovine surgical valves showed mixed or U-shaped responses, consistent with differences in true internal diameter and transcatheter valve oversizing. The selected ViV configurations completed 200 million accelerated wear cycles without gross structural failure under bench conditions.Conclusions In small ViV-transcatheter aortic valve replacement, the hemodynamic effects of implantation depth are valve-combination specific. A depth-window strategy may improve acute hydrodynamic performance, but clinical translation requires balancing hemodynamic benefit against leaflet deformation and durability-related uncertainty.
SN - 2772-3747
ER -