# Analysis of aortic valve prostheses using advanced cardiovascular imaging—a patient-specific reversed translational approach

## TL;DR

This study compares different aortic valve prostheses using advanced imaging to understand their hemodynamic effects and improve patient outcomes.

## Contribution

The novel approach combines patient-specific 3D printing with advanced cardiovascular imaging to compare valve prostheses in a translational setup.

## Key findings

- RDAVR and TAVR prostheses showed distinct flow rate differences detected by ultrasound.
- 4D flow MRI revealed elevated wall shear stress regions without significant prosthesis-specific differences.
- RDAVR prostheses caused higher energy loss in smaller aortic models compared to larger ones.

## Abstract

Rapid-deployment and transcatheter aortic valve replacement (RDAVR and TAVR) are standard treatment options for aortic valve disease. The lack of uniformity in size labelling and potentially adverse hemodynamic effects emphasize the need for an in-depth comparison of available prostheses. State-of-the-art valves (INTUITY Elite, Perceval, SAPIEN 3 Ultra and Evolut PRO+) were implanted into a patient-specific 3D printed aortic phantom with an annulus size recommended for the evaluated valves. The model was incorporated into a flow loop setup. Analysis of hemodynamic parameters was performed using advanced cardiovascular imaging (4D flow MRI and vector (V) flow ultrasound (US)). US revealed systematic differences in flow rates between RDAVR and TAVR prostheses. 4D flow analysis revealed localized regions of elevated WSS heterogeneously distributed without relevant differences between the prostheses. RDAVR prostheses showed higher kinetic energy loss (EL) along the thoracic aorta in small- compared to large-diameter models. EOA estimations ranged from 2.02 to 2.69 cm2 for RDAVR to 1.71 cm2 for 23 mm TAVR. Pressure gradients varied strongly between prosthesis types. Blood flow characteristics presented notable differences between the considered prostheses. This interdisciplinary approach provides a foundation for interpreting clinical outcomes after TAVR or RDAVR and potentially reduce the risk of prosthesis-patient mismatch.

The online version contains supplementary material available at 10.1038/s41598-026-44295-w.