{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"institution":[{"name":"bioRxiv"}],"indexed":{"date-parts":[[2026,4,25]],"date-time":"2026-04-25T12:45:44Z","timestamp":1777121144188,"version":"3.51.4"},"posted":{"date-parts":[[2026,4,21]]},"group-title":"Bioengineering","reference-count":24,"publisher":"openRxiv","license":[{"start":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T00:00:00Z","timestamp":1776729600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/www.biorxiv.org\/about\/FAQ#license"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"accepted":{"date-parts":[[2026,4,21]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>Transcatheter aortic valve replacement has transformed the management of aortic stenosis; however, adverse outcomes such as leaflet thrombosis and hypoattenuating leaflet thickening remain clinically significant concerns. Flow disturbances resulting from valve canting may alter local hemodynamics and promote thrombogenic conditions. We investigated how modest transcatheter heart valve canting alters cusp-specific sinus flow and washout and promotes localized thrombogenic microenvironments associated with leaflet surface thrombus formation using particle image velocimetry, a physiologic blood loop, and tissue analysis.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>A patient-derived aortic root model was used to evaluate the hemodynamic and thrombogenic effects of THV canting at -10\u00b0 (anti-curvature), 0\u00b0 (neutral), and +10\u00b0 (along-curvature). High-resolution particle image velocimetry quantified sinus flow fields and washout characteristics, and complementary whole-blood loop experiments enabled histologic assessment of leaflet-associated thrombus formation.<\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>\n                    Canting redistributed systolic jet orientation and sinus recirculation in a direction-dependent manner while preserving global hemodynamic measurements. The most spatially constrained cusp showed the largest increase in stasis and the slowest washout. In the right coronary cusp, anti-curvature canting increased the fraction of sinus area with velocity magnitude &lt;0.05 m\/s to 92% versus 43% in neutral and 10% in along-curvature deployments, and prolonged neo-sinus (T\n                    <jats:sub>90<\/jats:sub>\n                    ) washout to 4.7 cycles versus 2.9 and 1.8 cycles, respectively. Histology localized surface-adherent platelet\/fibrin thrombus to these poorly washed regions, most prominently on the right coronary cusp leaflet in anti-curvature deployments. Left and noncoronary cusp responses shifted with tilt direction, indicating redistribution rather than uniform worsening of thrombogenic conditions.\n                  <\/jats:p>\n                <\/jats:sec>\n                <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Even modest noncoaxial deployment is sufficient to create sinus-resolved throm-bogenic microenvironments that are not captured by global gradient or effective orifice area. Deployment configuration is therefore a modifiable determinant of post-TAVR leaflet throm-bosis risk and may contribute to HALT.<\/jats:p>\n                <\/jats:sec>","DOI":"10.64898\/2026.04.17.719323","type":"posted-content","created":{"date-parts":[[2026,4,21]],"date-time":"2026-04-21T20:35:24Z","timestamp":1776803724000},"source":"Crossref","is-referenced-by-count":0,"title":["Noncoaxial Transcatheter Aortic Valve Deployment Creates Cusp-Specific Thrombogenic Microenvironments Through Altered Sinus Hemodynamics"],"prefix":"10.64898","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-3121-4768","authenticated-orcid":false,"given":"Thangam","family":"Natarajan","sequence":"first","affiliation":[{"name":"Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Jae Hyun","family":"Kim","sequence":"additional","affiliation":[{"name":"Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christian","family":"Salgado","sequence":"additional","affiliation":[{"name":"Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Akshita","family":"Jha","sequence":"additional","affiliation":[{"name":"Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Cole","family":"Baker","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stephanie L.","family":"Sellers","sequence":"additional","affiliation":[{"name":"Cardiovascular Translational Lab, Centre for Cardiovascular Innovation, Centre for Heart Lung Innovation, University of British Columbia, Vancouver, Canada"},{"name":"Centre for Heart Valve Innovation and Centre for Cardiovascular Innovation, University of British Columbia, Vancouver, Canada"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8873-0387","authenticated-orcid":false,"given":"Joseph","family":"Aslan","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5267-3376","authenticated-orcid":false,"given":"Monica","family":"Hinds","sequence":"additional","affiliation":[{"name":"Department of Biomedical Engineering, Oregon Health and Science University, Portland, Oregon, USA"},{"name":"Division of Metabolic Health and Disease, Oregon National Primate Research Center, Oregon Health and Science University, Portland, Oregon, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ajit P.","family":"Yoganathan","sequence":"additional","affiliation":[{"name":"Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lakshmi Prasad","family":"Dasi","sequence":"additional","affiliation":[{"name":"Wallace H Coulter Department of Biomedical Engineering, Georgia Institute of Technology, Atlanta, Georgia, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"54368","reference":[{"key":"2026042505153526000_2026.04.17.719323v1.1","doi-asserted-by":"crossref","first-page":"44","DOI":"10.3389\/fcvm.2019.00044","article-title":"Clinical valve thrombosis and subclinical leaflet thrombosis following transcatheter aortic valve replacement: is there a need for a patient-tailored antithrombotic therapy?","volume":"6","year":"2019","journal-title":"Front Cardiovasc Med"},{"key":"2026042505153526000_2026.04.17.719323v1.2","doi-asserted-by":"publisher","DOI":"10.1056\/NEJMoa1509233"},{"key":"2026042505153526000_2026.04.17.719323v1.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(17)30757-2"},{"key":"2026042505153526000_2026.04.17.719323v1.4","doi-asserted-by":"crossref","unstructured":"Leon MB , Mack MJ , Pibarot P , Hahn RT , Thourani VH , Kodali SH , G\u00e9n\u00e9reux P , Kapadia SR , Cohen DJ , Pocock SJ , et al. 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