{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T14:01:10Z","timestamp":1789048870900,"version":"build-2803163510"},"reference-count":33,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"5","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2020,3,3]]},"abstract":"<jats:sec xml:lang=\"en\">\n            <jats:title>Background<\/jats:title>\n            <jats:p xml:lang=\"en\">Mixed valvular disease (MVD), mitral regurgitation (MR) from pre\u2010existing disease in conjunction with paravalvular leak (PVL) following transcatheter aortic valve replacement (TAVR), is one of the most important stimuli for left ventricle (LV) dysfunction, associated with cardiac mortality. Despite the prevalence of MVD, the quantitative understanding of the interplay between pre\u2010existing MVD, PVL, LV, and post\u2010TAVR recovery is meager.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Methods and Results<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              We quantified the effects of MVD on valvular\u2010ventricular hemodynamics using an image\u2010based patient\u2010specific computational framework in 72 MVD patients. Doppler pressure was reduced by TAVR (mean, 77%; N=72;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05), but it was not always accompanied by improvements in LV workload. TAVR had no effect on LV workload in 22 patients, and LV workload post\u2010TAVR significantly rose in 32 other patients. TAVR reduced LV workload in only 18 patients (25%). PVL significantly alters LV flow and increases shear stress on transcatheter aortic valve leaflets. It interacts with mitral inflow and elevates shear stresses on mitral valve and is one of the main contributors in worsening of MR post\u2010TAVR. MR worsened in 32 patients post\u2010TAVR and did not improve in 18 other patients.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec xml:lang=\"en\">\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p xml:lang=\"en\">\n              PVL limits the benefit of TAVR by increasing LV load and worsening of MR and heart failure. Post\u2010TAVR, most MVD patients (75% of N=72;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05) showed no improvements or even worsening of LV workload, whereas the majority of patients with PVL, but without that pre\u2010existing MR condition (60% of N=48;\n              <jats:italic>P<\/jats:italic>\n              &lt;0.05), showed improvements in LV workload. MR and its exacerbation by PVL may hinder the success of TAVR.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/jaha.119.015063","type":"journal-article","created":{"date-parts":[[2020,2,28]],"date-time":"2020-02-28T10:00:29Z","timestamp":1582884029000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":37,"title":["Mixed Valvular Disease Following Transcatheter Aortic Valve Replacement: Quantification and Systematic Differentiation Using Clinical Measurements and Image\u2010Based Patient\u2010Specific In Silico Modeling"],"prefix":"10.1161","volume":"9","author":[{"given":"Zahra","family":"Keshavarz\u2010Motamed","sequence":"first","affiliation":[{"name":"Department of Mechanical Engineering McMaster University Hamilton Ontario Canada"},{"name":"Institute for Medical Engineering and Science Massachusetts Institute of Technology Cambridge 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