Lesion-specific design and oversizing as strategies for TAVI optimization: A patient-specific finite element study

Oversizing and lesion-specific stent designs are evaluated as optimization strategies to reduce paravalvular leakage in TAVI procedures. Oversizing eliminates gaps but significantly increases tissue stress, posing safety concerns. Conversely, lesion-specific designs achieve optimal balance, effectively reducing gap areas while maintaining acceptable tissue stress. Correlation analysis further clarifies the relationships between design parameters and device performance, guiding future TAVI optimization strategies. • Optimization of TAVI stent performance based on oversizing and lesion-specific design. • Oversizing improves TAVI outcomes but requires careful balancing of tissue damage. • Localized strut modifications enhance expansion and sealing with controlled stress levels. • Reduced stent stiffness lowers tissue stress levels, while increased stent expansion improves annular sealing by minimizing gaps and enhancing the contact area. Transcatheter aortic valve implantation (TAVI) is a revolutionary intervention for aortic stenosis, yet complications such as paravalvular leakage (PVL) and excessive tissue stress remain prevalent, particularly in anatomies with elliptical aortic roots. This study develops geometric optimization strategies—specifically stent oversizing and lesion-specific design—to enhance sealing performance and reduce adverse mechanical interactions. A patient-specific finite element model of the aortic root was developed from CT imaging, and various stent designs were simulated, including alterations in strut thickness, width, and length. The evaluation compared conventional and modified stent configurations under standardized deployment conditions, including the effect of oversizing. Key metrics such as stress distribution, annulus gap area, and stent–aorta contact were particularly analyzed to assess device performance. A correlation analysis was conducted to identify interdependencies among the structural stiffness of the stents and deployment behaviors. Findings highlight the trade-offs between expansion, sealing, and mechanical response, emphasizing that tailored stent designs—particularly those with localized strut modifications—can achieve improved balance in anatomically challenging cases. The computational framework established in this study supports future TAVI optimization by linking stent design to patient-specific deployment outcomes.