3D software helps cardiologists plan ahead for TAVR complications
At high-volume transcatheter aortic valve replacement (TAVR) centers, even low complication rates translate into real-world risk when hundreds of procedures are performed each year. At Sentara Heart Hospital, clinicians are turning to advanced 3D cardiac CT modeling software to further reduce those risks and tailor valve selection to each patient’s unique anatomy.
Matthew Summers, MD, program director for structural heart at Sentara, said his team began using AI-enabled 3D planning software from DASI Simulations to improve procedural precision, particularly in complex and younger TAVR patients.
DASI has a partnership with Medtronic to help enhance outcomes with Medtronic's Evolut TAVR platform. Sentara uses Evolut for approximately 70% of its TAVR procedures, with the Abbott Navitor and Edwards Lifesciences Sapien 3 valves accounting for the other 30%.
“We run a very large volume TAVR center in coastal Virginia, performing about 500 TAVRs a year,” Summers explained in a video interview with Cardiovascular Business. “We are increasingly tasked with taking care of not just more and more complex TAVRs, including valve-in-valves and redos of patients coming back after their initial valve therapy, but also an increasing percentage of patients that are younger that are lower risk. They all have an expectation of a perfect procedure without any really complications or issues.”
Complications are rare, but when they do happen, it can be catastrophic or fatal. Summers and his colleagues needed a way to better identify patients who pose an increased risk of experiencing a complication. Traditional TAVR planning software was not able to identify these patients.
Moving beyond static CT planning for TAVR
Traditional TAVR planning relies heavily on cardiac CT imaging with extensive manual measurements. While effective, Summers said static CT analysis can lack the precision needed to anticipate rare, catastrophic complications such as annular rupture or coronary occlusion.
“In a big center, we needed a way to individualize therapy for individual anatomy, because planning was not just labor intensive, but traditional CT measurements and CT pre-planning felt insufficient all along,” he said.
The Sentara team previously explored 3D printing models for complex cases, but found that static models did not adequately simulate tissue deformation or predict how a transcatheter valve frame would interact with calcium and the patient's native anatomy.
The DASI platform uses index CT scans and dynamically models how specific valve frames expand within a patient’s anatomy, incorporating 30-day post-implant data to simulate stent expansion, depth and deformation. This enables physicians to virtually test different valve platforms, sizes and implant depths before entering the cath lab.
Predicting rare but devastating TAVR complications
A key advantage of the software is its ability to better predict coronary occlusion risk. Rather than relying solely on 2D measurements such as valve-to-coronary (VTC) and valve-to-sinotubular junction (VTSTJ) distances, the platform uses AI-derived 3D narrowing assessments and a DLC/D ratio to evaluate how displaced leaflets or sinus sequestration could impede coronary flow.
“What it's allowed us to do is be more predictive of those patients that are truly at risk,” Summers said.
By modeling how calcium protrudes or how tissue deforms in response to a specific stent frame, the system helps the heart team identify patients at risk for annular rupture, coronary occlusion, conduction disturbances and elevated post-procedural gradients.
“The idea ... is to individualize therapy,” he said. “We use it uniformly now in patients for index valve selection."
Tailoring TAVR valve choice and implant strategy
Sentara currently uses multiple TAVR platforms because Summers emphasized that no single platform fits all anatomies.
"Individualizing the therapy and choosing your valve based on the individual risks of that valve in that patient's individual anatomy, I think, is the holy grail of this," he said.
With the 3D modeling, the team can simulate the consequences of downsizing a valve, switching platforms or adjusting implant depth. This allows operators to balance risks of coronary obstruction, paravalvular leak, pacemaker implantation and long-term durability— considerations that are increasingly important as TAVR expands into younger, lower-risk populations.
Summers said the modeling also provides insight into commissural alignment and future coronary access, critical for patients who may require redo TAVR procedures or require percutaneous coronary intervention (PCI) later in life.
Reducing unnecessary leaflet modification
One of the most tangible impacts has been a reduction in leaflet modification procedures, such as BASILICA, in valve-in-valve cases. In 2023, Summers said about 10% of Sentara’s TAVR volume consisted of valve-in-valve procedures. Historically, about half of those patients underwent leaflet modification to mitigate coronary occlusion risk.
By incorporating 3D modeling and more sophisticated risk assessments, he said the number of leaflet modification procedures dropped by more than 70%.
“It's giving us a lot of confidence that we're applying those types of complex procedures to the patients that actually need them the most and are at highest risk for it,” he said. “But it also is safeguarding the patients that didn't necessarily need it.”
Rather than defaulting to a preferred valve platform, the goal is to let patient anatomy and data-driven risk modeling dictate therapy, he explained.
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]