Aortic stenosis (AS) is the most common valvular heart disease in developed countries and has a high mortality rate if left untreated. Transcatheter Aortic Valve Implantation (TAVI) is the most common treatment for AS in patients at intermediate and high-risk for surgery. As its use expands to younger, lower-risk patients with longer life expectancies, TAVI's bioprosthetic durability holds increasing importance for its utility. Additional factors such as turbulent flow patterns in the aortic root, which may affect long-term hydrodynamic performance, device durability, and thrombus formation, are thus critical to consider alongside traditional measures of TAVI success.
We present a standardised Computational Fluid Dynamics (CFD) pipeline, based on clinical echocardiography and computed tomography (CT) data - including automated medical image processing, patient-specific model generation, flow simulation, and post-processing and analysis - to simulate turbulent aortic flow in individual AS patients undergoing TAVI. The pipeline is used to analyse flow patterns related to TAVI durability. We demonstrate its implementation in four retrospective clinical cases. Close collaboration with the clinical team ensures relevance, correct interpretation of clinical data, and consideration of crucial clinical context when analysing results.
Overall, we have developed a pipeline for constructing and analysing turbulent aortic flow in AS patients undergoing TAVI. By further automation and expansion of our pipeline to additional, potentially more complex clinical cases, we aim to provide a useful tool for clinicians to assess and predict TAVI durability in individual AS patients.