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Related Experiment Video

Updated: Jun 11, 2026

Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
06:59

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A Proposed Anatomical-Fluoroscopic Workflow to Identify the Optimal Split Line for Leaflet Modification in Redo-TAVR.

Takayuki Onishi1, Annapoorna S Kini1, Syed Zaid2

  • 1Mount Sinai Fuster Heart Hospital, New York, New York, USA.

JACC. Cardiovascular Interventions
|June 9, 2026
PubMed
Summary

This study clarifies leaflet anatomy in redo transcatheter aortic valve replacement (TAVR) and proposes an imaging-guided workflow for leaflet modification to improve outcomes.

Keywords:
coronary obstructionleaflet modificationredo transcatheter aortic valve replacement

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Area of Science:

  • Cardiovascular Surgery
  • Interventional Cardiology
  • Biomedical Engineering

Background:

  • Optimal leaflet modification strategies for redo transcatheter aortic valve replacement (TAVR) require refinement.
  • Understanding the relationship between TAVR leaflets and cardiac structures is crucial for procedural success.

Purpose of the Study:

  • To anatomically characterize transcatheter aortic valve leaflets, suture lines, nodes, and commissural tabs.
  • To develop a workflow guiding leaflet modification in redo-TAVR procedures.

Main Methods:

  • Analysis of leaflet suture lines and their relation to nodes and commissural posts across four TAVR valve types (SAPIEN 3, Evolut, Navitor, ACURATE neo2).
  • Classification of leaflet regions into modifiable, challenging, or nonmodifiable zones.
  • Identification of vertical leaflet split lines and fluoroscopic landmarks, utilizing preprocedural CT to optimize split line placement relative to coronary ostia.

Main Results:

  • Detailed mapping of leaflet suture lines and their relationship with valve frames and commissural posts.
  • Quantification of proposed split line numbers and lengths for each valve type.
  • Identification of optimal split line orientations using preprocedural CT to prevent coronary obstruction and a proposed 4-step modification workflow.

Conclusions:

  • A systematic, imaging-guided approach for leaflet modification in redo-TAVR is proposed.
  • Ongoing studies aim to validate the feasibility and effectiveness of this novel workflow.