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

Valle, NJ; Saleh, OA; Jafar, O; Munoz-Moreno, J; Harper, AM; Martin, CM; Dolsen, JD; Benza, RL; Kemp, CD; Parikh, PK; Mahoney, PD; Talreja, DR; Peterson, BD; Cohen, JA; Summers, MR

doi:10.1016/j.jacadv.2026.103377

Valvular & structural heart disease

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

JACC AdvPublished 23 Oct 2026retrospective analysis of consecutive patients

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Authors' conclusion

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.

Study context

Population: Patients undergoing valve-in-valve (ViV) transcatheter aortic valve replacement (TAVR) or redo-TAVRconsecutive ViV TAVR or redo-TAVR patients · computed tomography angiography (CTA) high-risk, non-CPM 62 · CTA high-risk, computational predictive modeling (CPM) 29
Participants: 157 patients

Exposure: non-CPM vs CPM
non-CPMn = 62
CPMn = 29reference
Outcome: Leaflet modification with only conventional CTA-based planning

Methodological detailstreated from 2022 to 2025, Boschloo's one-sided exact test, counterfactual binomial analysis

Treated from 2022 to 2025
Boschloo's one-sided exact test
Counterfactual binomial analysis

Main finding

As reported in the abstract

ViV TAVR26.3%

redo-TAVR24.1%

Observational data: associations, not effects.

Further findings

Outcome	non-CPM	CPM	← Lower with non-CPM ←→ Higher with non-CPM →	OR for leaflet modification (95% CI)	P value
Leaflet modification among patients deemed high risk for CO by conventional methodsBoschloo's one-sided exact test	46.8%	24.1%	0.10.31310	2.76 (1.03–7.40)	P = 0.021
			0.10.31310OR for leaflet modification (log scale)

Leaflet modification among patients deemed high risk for coronary obstruction (CO) by conventional methods: leaflet modification significantly lower in the CPM-augmented subgroup; direction of the OR inferred from the group rates, not stated in the abstract

CPM risk reclassification

Reclassified to low-risk status by CPM-augmented planning: 82.8%
Of reclassified patients, managed without leaflet modification: 79.2%

Safety

Coronary obstruction · study period

No COs occurred during the study period

Original publication

Computational Modeling Reduces Leaflet Modification Rates in Valve-In-Valve and Redo Transcatheter Aortic Valve Replacement. JACC Adv. Published 23 October 2026. doi:10.1016/j.jacadv.2026.103377

Read the original article ↗

Summarised from the published abstract; every number is checked against it