The interplay between paravalvular leakage and coronary artery diseases following transcatheter aortic valve replacement

Transcatheter aortic valve replacement (TAVR) has surpassed the traditional surgical aortic valve replacement for patients who suffer from aortic stenosis. While TAVR continues to gain traction in the field of cardiology, postoperative complications such as paravalvular leakage (PVL) become necessary to tackle. Although coronary artery disease (CAD) is present in approximately 50% of the TAVR population, the correlation between PVL and CAD has not been understood yet. Despite the prevalence of PVL, the quantitative understanding of the interplay between pre-existing valvular pathologies, PVL, CAD and post-TAVR recovery is inadequate. In this study we developed a Doppler-based and patient-specific lumped-parameter model as well as a fluid-solid interaction modeling framework, that takes interactions of the valves, left ventricle, and arterial system into account, to estimate the LV workload (global hemodynamics) and 3-D blood flow dynamics inside the coronary arteries (local hemodynamics) non-invasively. Based on our present findings, PVL limits the benefits of TAVR and restricts coronary perfusion due to the lack of sufficient coronary blood flow. Moreover, PVL may increase the LV load (ventricular volume overload) and decrease the coronary wall shear stress (low wall shear stress promotes atherosclerosis development or plaque progression through loss of the physiological flow-oriented alignment of the endothelial cells).