Effect of coronary artery height on neo-sinus blood residence time after transcatheter aortic valve replacement

Thrombosis in the neo-sinus region is a significant complication following transcatheter aortic valve replacement (TAVR), affecting 15–20% of patients and contributing to valve dysfunction and stroke. A key hemodynamic factor in thrombosis formation is the blood residence time (BRT) in the neo-sinus, which may be influenced by coronary artery height (HC). However, the relationship between HC and BRT remains poorly understood. In this study, we quantify the impact of HC on BRT using in-vitro flow loop experiments and predictive modeling. Patient-specific aortic root models were fabricated from computed tomography scans and implanted with commercial TAVR valves. Particle image velocimetry was used to assess flow patterns and measure BRT. To isolate the role of HC, we generated synthetic variations by adjusting coronary height and heart rate while preserving anatomical fidelity. A machine learning model was trained to predict BRT based on these parameters and validated with test data. This work provides new insights into flow stasis in the neo-sinus region and demonstrates the utility of combining experimental hemodynamics with data-driven modeling for thrombosis risk prediction. These findings have implications for device design and patient-specific treatment planning after TAVR.