Valvular & structural heart diseaseCohort study
Leaflet Modification to Mitigate Coronary Obstruction Risk During Transcatheter Aortic Valve Replacement (TAVR)
- Registry study
- international
- multicentre
- consecutive patients
- Median follow-up 100 days (Q1-Q3: 30-443 days)
Authors' conclusion
Leaflet modification techniques demonstrated high technical feasibility across a broad anatomical spectrum but carried considerable early clinical risk.
Study context
- Population
- Patients at high risk for coronary obstruction undergoing leaflet modification before TAVR (September 2019 to January 2026)139 native valves
- Participants
- 293 patients
- Exposure
- Leaflet-splitting vs Intraleaflet disruption
- Leaflet-splittingn = 202
- Intraleaflet disruptionn = 91
- Outcome
- Coprimary: leaflet modification-directed technical success and VARC-3 technical success
Main finding
As reported in the abstract
Leaflet modification-directed technical success, 251 of 293
85.7% (95% CI 81.0%-89.4%)
VARC-3 technical success, 254 of 293
86.7% (95% CI 82.1%-90.3%)
Observational data: associations, not effects.
Secondary outcomes
Successful leaflet traversal and modification (per leaflet)
- Leaflet traversal, 310 of 318 leaflets
- 97.5% (95% CI 94.9%-98.9%)
- Leaflet modification, 306 of 318 leaflets
- 96.2% (95% CI 93.3%-97.9%)
TAVR without coronary obstruction (CO) events
- Patients without CO events
- 91.1% (95% CI 87.1%-94.0%)
Safety
Delayed CO
- Delayed CO, 3 of 293
- 1.0% (95% CI 0.3%-3.0%)
Freedom from VARC-3 early safety · 30 days
- Freedom from VARC-3 early safety, 181 of 293
- 61.8% (95% CI 56.5%-67.6%)
Original publication
Leaflet Modification to Mitigate Coronary Obstruction Risk During TAVR. JACC Cardiovasc Interv. Published 22 June 2026. doi:10.1016/j.jcin.2026.05.011
Summarised from the published abstract; every number is checked against it