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Thinner biological tissues induce leaflet flutter in aortic heart valve replacements

Significance Percutaneous valve replacement procedures enable the deployment of bioprosthetic heart valves through a catheter, which offers a minimally invasive option to treat valvular heart disease. Although these bioprostheses typically employ thinner leaflet tissues to accommodate the collapsed valve dimensions, the impact of using such tissues remains poorly understood. This study used high-fidelity computational methods to model realistic aortic valve implants and analyze the behavior of thinner tissues in the valvular system. The results from this investigation provide essential knowledge about a previously understudied phenomenon and indicate that thinner, more flexible biological tissues induce significant leaflet flutter during the cardiac cycle. This observed response introduces blood flow disturbances and leaflet irregularities that can lead to cardiovascular dysfunction and reduced valve durability. Valvular heart disease has recently become an increasing public health concern due to the high prevalence of valve degeneration in aging populations. For patients with severely impacted aortic valves that require replacement, catheter-based bioprosthetic valve deployment offers a minimally invasive treatment option that eliminates many of the risks associated with surgical valve replacement. Although recent percutaneous device advancements have incorporated thinner, more flexible biological tissues to streamline safer deployment through catheters, the impact of such tissues in the complex, mechanically demanding, and highly dynamic valvular system remains poorly understood. The present work utilized a validated computational fluid–structure interaction approach to isolate the behavior of thinner, more compliant aortic valve tissues in a physiologically realistic system. This computational study identified and quantified significant leaflet flutter induced by the use of thinner tissues that initiated blood flow disturbances and oscillatory leaflet strains. The aortic flow and valvular dynamics associated with these thinner valvular tissues have not been previously identified and provide essential information that can significantly advance fundamental knowledge about the cardiac system and support future medical device innovation. Considering the risks associated with such observed flutter phenomena, including blood damage and accelerated leaflet deterioration, this study demonstrates the potentially serious impact of introducing thinner, more flexible tissues into the cardiac system.