Computational Modeling Reduces Leaflet Modification Rates in Valve-In-Valve and Redo Transcatheter Aortic Valve Replacement

@article{nicholasjvalle2026computational,
  title = {{Computational Modeling Reduces Leaflet Modification Rates in Valve-In-Valve and Redo Transcatheter Aortic Valve Replacement}},
  author = {Nicholas J. Valle, DO and Omar A. Saleh, MD and Omar Jafar, MD and Juan Munoz-Moreno, MD and Ann M. Harper, MPH and Chelsea M. Martin, RN, BSN and Joshua D. Dolsen, MD and Raymond L. Benza, MD and Clinton D. Kemp, MD and Parth K. Parikh, MD and Paul D. Mahoney, MD and Deepak R. Talreja, MD and Benjamin D. Peterson, MD and Joshua A. Cohen, MD and Matthew R. Summers, MD},
  journal = {JACC: Advances},
  year = {2026},
  month = oct,
  doi = {10.1016/j.jacadv.2026.103377},
  url = {https://doi.org/10.1016/j.jacadv.2026.103377},
  note = {CC BY 4.0},
}

TY  - JOUR
TI  - Computational Modeling Reduces Leaflet Modification Rates in Valve-In-Valve and Redo Transcatheter Aortic Valve Replacement
AU  - Nicholas J. Valle, DO
AU  - Omar A. Saleh, MD
AU  - Omar Jafar, MD
AU  - Juan Munoz-Moreno, MD
AU  - Ann M. Harper, MPH
AU  - Chelsea M. Martin, RN, BSN
AU  - Joshua D. Dolsen, MD
AU  - Raymond L. Benza, MD
AU  - Clinton D. Kemp, MD
AU  - Parth K. Parikh, MD
AU  - Paul D. Mahoney, MD
AU  - Deepak R. Talreja, MD
AU  - Benjamin D. Peterson, MD
AU  - Joshua A. Cohen, MD
AU  - Matthew R. Summers, MD
PY  - 2026
DA  - 2026/10/23
JO  - JACC: Advances
DO  - 10.1016/j.jacadv.2026.103377
UR  - https://doi.org/10.1016/j.jacadv.2026.103377
AB  - Background: Coronary obstruction (CO) complicates valve-in-valve (ViV) and redo transcatheter aortic valve replacement (TAVR) at higher rates than native TAVR. Leaflet modification mitigates this risk but increases procedural burden. Traditional computed tomography angiography (CTA)-based risk stratification relies on static parameters that may overestimate risk; computational predictive modeling (CPM) uses patient-specific data to refine risk assessment. Objectives: The study aims to characterize leaflet modification rates in conventional ViV TAVR and redo-TAVR and evaluate the impact of CPM preprocedural planning augmentation on leaflet modification rates. Methods: A total of 157 consecutive ViV TAVR or redo-TAVR patients treated from 2022 to 2025 were retrospectively analyzed. CO risk status was derived from traditional CTA parameters. Leaflet modification rates among CTA high-risk subgroups (non-CPM, n = 62; and CPM, n = 29) were compared using Boschloo's one-sided exact test. CPM risk-reclassification patterns were studied using counterfactual binomial analysis. Results: Leaflet modification occurred in 26.3% of ViV TAVR and 24.1% of redo-TAVR procedures that used only conventional CTA-based planning methods. Among patients deemed high risk for CO by conventional methods, leaflet modification was significantly lower in the CPM-augmented subgroup vs that in the non-CPM subgroup (24.1% vs 46.8%; OR: 2.76; 95% CI: 1.03-7.40; P = 0.021). CPM-augmented planning reclassified 82.8% of patients to low-risk status, and 79.2% of reclassified patients were managed without leaflet modification. No COs occurred during the study period. Conclusions: Among ViV TAVR and redo-TAVR patients at high risk of CO based on conventional CTA-based planning, the use of CPM to augment standard risk assessment was associated with a significant reduction in leaflet modification procedures.
SN  - 2772-963X
ER  -