Key result
Patient-specific computational modeling safely guides redo TAVR without requiring leaflet modification or coronary protection.
Why the study?
Borderline coronary risk assessment by CT in redo TAVR requires coronary-specific interpretation and may benefit from patient-specific computational modeling for procedural planning.
Does computational modeling (DASI) improve safety planning by predicting adequate coronary clearance in redo TAVR with borderline CT findings?
Case Report (n=1)
No
Does computational modeling (DASI) improve safety planning by predicting adequate coronary clearance in redo TAVR with borderline CT findings?
Computational modeling can reassure operators and avoid unnecessary leaflet modification during redo TAVR in patients with borderline CT coronary clearance measurements.
Answers are grounded in this paper and cite their sources.
May enable safe redo TAVR without leaflet modification in borderline cases; leaves open prospective validation before wider adoption.
IMAGE(S): Computed tomography (CT) and computational modeling (DASI) in redo transcatheter aortic valve replacement (TAVR) planning. CASE SUMMARY: A 77-year-old woman presented with severe symptomatic aortic stenosis due to degeneration of a prior transcatheter valve. CT demonstrated leaflet calcification with borderline left-sided valve-to-coronary distance (3.27 mm). Geometric assessment suggested low right coronary obstruction risk, but higher left main risk. Computational modeling demonstrated adequate leaflet-coronary clearance (distance from displaced leaflet cusp to coronary ostium normalized to coronary diameter >0.7). Redo TAVR with a 26-mm Evolut FX was performed without leaflet modification and no coronary obstruction. TAKE-HOME MESSAGE: Borderline CT findings in redo TAVR require coronary-specific interpretation; computational modeling may provide reassurance when avoiding leaflet modification.
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McKechnie et al. (2026) conducted a case report in Severe symptomatic aortic stenosis due to bioprosthetic valve degeneration (n=1). Preprocedural computational modeling (DASI) for redo TAVR planning was evaluated on Coronary obstruction during/after redo TAVR. Patient-specific computational modeling for redo TAVR in a patient with borderline CT findings demonstrated adequate coronary clearance, safely enabling intervention without leaflet modification or coronary protection.
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