Bioprosthetic Aortic Valve Diameter and Thickness Are Directly Related to Leaflet Fluttering: Results from a Combined Experimental and Computational Modeling Study

Bioprosthetic heart valves (BHVs) are commonly used in surgical and percutaneous valve replacement, and surgical valves have been shown to have a time to reintervention of 10--15 years. Further, smaller-diameter surgical BHVs generally have higher-rates of prosthesis-patient mismatch than larger valves. Bioprosthetic aortic valves can flutter in systole, and fluttering is associated with fatigue and failure in natural and manufactured structures. The determinants of flutter in BHVs have not been well characterized, however, despite their potential to impact BHV durability. We use an experimental pulse duplicator platform and a computational model of this system to study the role of device geometry on BHV dynamics. We systematically characterize the impact of BHV diameter and leaflet thickness on fluttering dynamics. Ultimately, understanding the effects of device geometry on leaflet kinematics may lead to more durable valve replacements.