A Study on the Measurement of Calcification in Bicuspid Aortic Valves

Abstract

Transcatheter aortic valve implantation (TAVI) is widely used in the clinical treatment of severe aortic stenosis. Functionally bicuspid patients are increasingly included in TAVI cohorts. However, their pronounced geometric variability introduces additional challenges for device deployment and procedural outcomes. This underscores the importance of analyzing this subgroup in greater detail. Virtual cohorts and in silico studies provide a suitable framework for systematically investigating such anatomical variations. To assess whether synthetically generated calcification patterns reproduce the constrictive effects observed in real functionally bicuspid patient data, we defined a parameter describing the calcified connection between the leaflets as quantitative criterion. Using pyVista, we quantified the maximum extent of these calcified connections in 40 segmented, functionally bicuspid human aortic valves. The measurement demonstrated a high degree of reproducibility, with six independent observers obtaining comparable results. The longest and most frequent calcified connections were observed between the right-coronary cusp (RCC) and the left-coronary cusp (LCC). Among patients exhibiting only a single calcified connection, the mean normalized bridging extent was 62% for RCC and LCC, 54% for non-coronary cusp (NCC) and RCC and 34% for LCC and NCC. These findings provide essential quantitative insight into calcification-induced leaflet constriction in functionally bicuspid anatomies and support the validation of virtual TAVI cohorts.