A Systematic Review of Modeling Platforms for Atrioventricular Valves in Atrioventricular Septal Defects
Clinical Snapshot
PICO Framework
| P — Population | Patients with atrioventricular septal defects (AVSD), including both complete and partial forms, across paediatric and adult populations; also encompasses animal and computational models designed to replicate AVSD valve anatomy and physiology |
| I — Intervention | Modeling platforms for atrioventricular valves in AVSD — encompassing in silico (computational/finite element), in vitro (bench-top, 3D-printed, flow-loop), and in vivo (animal model) approaches |
| C — Comparator | No single active comparator; implicit comparison across the three modeling modalities (in silico vs. in vitro vs. in vivo) and between AVSD-specific and non-AVSD congenital/acquired valve models |
| O — Outcomes | Fidelity of anatomical and haemodynamic replication; applicability to AVSD valve pathology; utility for evaluating surgical repair strategies; reproducibility; physiological accuracy; translational potential to clinical practice |
Bottom Line
This systematic review maps the current state of modeling platforms for atrioventricular valves in atrioventricular septal defects (AVSD) — a congenital cardiac condition with persistently high re-intervention rates. Across 47 included studies, the authors identify three modality categories: in silico (computational), in vitro (bench-top), and in vivo (animal) models. Each has meaningful limitations: computational models rarely target AVSD-specific anatomy; in vitro platforms have not yet been applied to AVSD valve repair; and animal models struggle to replicate the unique AVSD pathology. The review is methodologically limited — it lacks formal risk of bias assessment, GRADE evidence grading, and transparent reporting of search strategy details, placing it at the lower end of systematic review rigour. It functions more as a structured narrative landscape analysis than a high-quality systematic review in the traditional clinical sense. Nevertheless, it provides genuine value by clearly delineating research gaps and advocating for multidisciplinary collaboration to develop validated, physiologically accurate AVSD valve models. For Australian congenital cardiac surgeons and biomedical engineers, this review serves as a useful reference point for research prioritisation, though it does not provide sufficient evidence to alter current surgical practice or institutional protocols.
Key Findings
Effect Size: Not applicable — narrative systematic review without quantitative synthesis
Primary Outcome: Characterisation of the current landscape of modeling platforms (in silico, in vitro, in vivo) for atrioventricular valves in AVSD, identifying capabilities, limitations, and gaps in each modality
Nnt Or Sensitivity: Not applicable — no diagnostic, therapeutic, or prognostic effect measures reported. Key finding: of 47 included studies, 14 were in silico, 26 in vitro, and 7 in vivo; none of the in vitro platforms had been specifically applied to AVSD valve repair at the time of review
Clinical Application
Direct clinical application is not yet feasible — the review identifies that no validated, AVSD-specific modeling platform currently exists that can reliably guide surgical decision-making. Future feasibility depends on multidisciplinary collaboration to develop high-fidelity, reproducible models. 3D printing and patient-specific computational fluid dynamics are the most near-term translatable technologies. AVSD is managed at major Australian paediatric cardiac surgical centres including the Royal Children's Hospital Melbourne, Sydney Children's Hospital Westmead, Queensland Children's Hospital, and Perth Children's Hospital. Australia's National Congenital Heart Disease Audit and the CCIF (Congenital Cardiac Interventions Forum) track re-intervention rates, which align with the international concern driving this review. The TGA does not currently regulate computational or bench-top modeling platforms as therapeutic devices, though 3D-printed surgical guides and patient-specific implants would require TGA oversight. RACGP guidelines do not directly address AVSD modeling, but general practitioner awareness of re-intervention risk is relevant for long-term follow-up planning. PBS does not list AVSD-specific pharmacological or device therapies that would be directly impacted by this research at present. Paediatric and adult patients with complete or partial AVSD, particularly those with Down syndrome (trisomy 21) who represent the largest AVSD subgroup and face the highest cumulative re-intervention burden. Also relevant to congenital cardiac surgeons, interventional cardiologists, and biomedical engineers developing next-generation valve repair tools and surgical simulators.
Abstract
Given the high rate of re-intervention in patients with atrioventricular septal defects (AVSD), there is a continuing need to accurately model the complex valve anatomy and surgical repair strategies. This systematic review examined the current scientific landscape for modeling platforms designed to study abnormal congenital heart valves that are used or could be used for AVSD investigation. Of 1,050 sources screened, 47 were included (14 in silico; 26 in vitro; 7 in vivo). In silico models studying valve pathologies have advanced in recent years, but few targeted AVSD valves. In vitro platforms allow comparisons of repair techniques, but have yet to be applied for AVSD valve repair. In vivo studies could offer physiologically accurate platforms, but face challenges such as replicating AVSD pathologies. Multidisciplinary approaches to creating high-fidelity, reproducible, physiologically accurate AVSD valve models can transform the understanding of AVSD valve properties and repair strategies.
References
- 1.Wang, C. C., Marx, M., Barth, E., D'Amore, A., Luo, H., & Coyan, G. (2026). A systematic review of modeling platforms for atrioventricular valves in atrioventricular septal defects. Journal of Cardiovascular Translational Research. https://doi.org/10.1111/aor.13626
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