FE-based risk assessment of coronary artery compression in pulmonary conduit pre-stenting: optimizing the balance between time-expense and reliability.

Background and objective: Calcific obstruction of the pulmonary conduit is a late complication of surgical implantation of a homograft in congenital patients. Percutaneous pulmonary valve implantation (PPVI) is an effective alternative to surgical repair. However, this procedure is affected by several complications, with coronary artery (CA) compression being one of the most severe. High-fidelity finite element (FE) models can provide accurate predictions but are too computationally expensive for routine use, whereas simplified models sacrifice mechanical fidelity. This study proposes a novel FE-based framework to investigate conduit pre-stenting feasibility, while aiming to balance computational efficiency with predictive accuracy within clinically relevant timelines. Methods: A semi-automated pipeline was developed, requiring manual input only for the segmentation of computed tomography (CT), virtual stent positioning, and simulation launch. Patient-specific geometries were meshed and processed through an automated Results: The full simulation process required less than 10 h per case, with minimal operator workload. FE-predicted stent configuration showed strong agreement with fluoroscopic measurements ( Conclusions: The proposed FE simulation framework enables patient-specific prediction of stent configuration and CA compression risk within clinically compatible timelines. The balanced trade-off between mechanical fidelity and computational efficiency supports its potential integration into pre-procedural planning of conduit pre-stenting and PPVI.