{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,4]],"date-time":"2026-09-04T22:30:50Z","timestamp":1788561050017,"version":"build-2803163510"},"reference-count":22,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"6","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["Circ: Cardiovascular Interventions"],"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n            <jats:title>BACKGROUND:<\/jats:title>\n            <jats:p>Patients with bicuspid aortic stenosis who receive transcatheter aortic valve replacement (TAVR) may require subsequent valve interventions in their lifetime; however, the feasibility of redo-TAVR in this population is uncertain. We aimed to assess redo-TAVR feasibility in bicuspid patients and develop a predictive virtual valve planning algorithm.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>METHODS:<\/jats:title>\n            <jats:p>We studied computed tomography scans of bicuspid patients who received a balloon-expandable transcatheter heart valve (THV) in the LRT trial (Low Risk TAVR). Redo-TAVR feasibility, determined by valve-to-coronary and valve-to-aorta measurements on 30-day computed tomography, was assessed according to raphe location and calcification. A virtual valve planning algorithm was developed using baseline and 30-day computed tomography scans.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>RESULTS:<\/jats:title>\n            <jats:p>\n              Among 42 patients (left\/right cusp fusion: n=34; right\/noncusp fusion: n=4; 2-sinus: n=4), redo-TAVR was feasible in 64%, while 36% would likely require leaflet modification to prevent coronary obstruction. Patients with left\/right fusion and calcified raphe had higher redo-TAVR feasibility (88% versus 35%,\n              <jats:italic toggle=\"yes\">P<\/jats:italic>\n              &lt;0.001) due to favorable shifting of the THV away from the coronary ostia. A bicuspid virtual planning algorithm accounting for 83.4% THV underexpansion, resulting in an 11.9% taller frame and translation of the THV away from the calcified raphe (mean valve shift 6.6 mm) achieved 86.7% sensitivity and 88.9% specificity for predicting redo-TAVR feasibility.\n            <\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>CONCLUSIONS:<\/jats:title>\n            <jats:p>Calcified raphe in left\/right cusp fusion shifts the THV away from the coronary ostia, reducing coronary obstruction risk during redo-TAVR. Underexpansion causing increased THV frame height and valve shifting is common in bicuspid patients; a virtual planning algorithm accounting for these aspects can accurately assess redo-TAVR risk.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>REGISTRATION:<\/jats:title>\n            <jats:p>\n              URL:\n              <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.clinicaltrials.gov\">https:\/\/www.clinicaltrials.gov<\/jats:ext-link>\n              ; Unique identifier: NCT02628899.\n            <\/jats:p>\n          <\/jats:sec>","DOI":"10.1161\/circinterventions.124.014802","type":"journal-article","created":{"date-parts":[[2025,4,22]],"date-time":"2025-04-22T09:00:31Z","timestamp":1745312431000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":3,"title":["Impact of Calcified Raphe on TAVR in Bicuspid Patients: Predicting Redo-TAVR Feasibility and Virtual Planning Implications"],"prefix":"10.1161","volume":"18","clinical-trial-number":[{"clinical-trial-number":"nct02628899","registry":"10.18810\/clinical-trials-gov"}],"author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-8913-7430","authenticated-orcid":true,"given":"Pavan","family":"Reddy","sequence":"first","affiliation":[{"name":"Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (P.R., I.M., I.B.-D., L.F.S., H.M.G.-G., R.W., T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Fernando J.","family":"Rodriguez-Weisson","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute, Washington, DC (F.J.R.-W., M.C., F.M.A., A.S.)."},{"name":"Georgetown University, Washington, DC (F.J.R.-W., F.M.A., A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9804-3786","authenticated-orcid":true,"given":"Giorgio A.","family":"Medranda","sequence":"additional","affiliation":[{"name":"Division of Cardiology, NYU Langone Hospital \u2013 Long Island, Mineola, NY (G.A.M.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3294-5968","authenticated-orcid":true,"given":"Ilan","family":"Merdler","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (P.R., I.M., I.B.-D., L.F.S., H.M.G.-G., R.W., T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matteo","family":"Cellamare","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute, Washington, DC (F.J.R.-W., M.C., F.M.A., A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6087-0898","authenticated-orcid":true,"given":"Paul","family":"Gordon","sequence":"additional","affiliation":[{"name":"Division of Cardiology (P.G.), Lifespan Cardiovascular Institute, Providence, RI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1470-6760","authenticated-orcid":true,"given":"Afshin","family":"Ehsan","sequence":"additional","affiliation":[{"name":"Division of Cardiothoracic Surgery (A.E.), Lifespan Cardiovascular Institute, Providence, RI."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0048-2789","authenticated-orcid":true,"given":"Puja","family":"Parikh","sequence":"additional","affiliation":[{"name":"Department of Medicine (P.P.), Stony Brook Hospital, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1765-3804","authenticated-orcid":true,"given":"Thomas","family":"Bilfinger","sequence":"additional","affiliation":[{"name":"Department of Surgery (T.B.), Stony Brook Hospital, NY."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9476-6255","authenticated-orcid":true,"given":"Maurice","family":"Buchbinder","sequence":"additional","affiliation":[{"name":"Foundation for Cardiovascular Medicine, Stanford University, CA (M.B.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Roberts","sequence":"additional","affiliation":[{"name":"Sutter Medical Center, Sacramento, Sutter Heart and Vascular Institute, Research, CA (D.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nicholas","family":"Hanna","sequence":"additional","affiliation":[{"name":"Ascension St. John Heart and Vascular Center, Cardiovascular Consultants, Tulsa, OK (N.H.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0006-6026-9097","authenticated-orcid":true,"given":"Itsik","family":"Ben-Dor","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (P.R., I.M., I.B.-D., L.F.S., H.M.G.-G., R.W., T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6446-2683","authenticated-orcid":true,"given":"Lowell F.","family":"Satler","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (P.R., I.M., I.B.-D., L.F.S., H.M.G.-G., R.W., T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-5100-0471","authenticated-orcid":true,"given":"Hector M.","family":"Garcia-Garcia","sequence":"additional","affiliation":[{"name":"Section of Interventional Cardiology, MedStar Washington Hospital Center, DC (P.R., I.M., I.B.-D., L.F.S., H.M.G.-G., R.W., T.R.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1744-5271","authenticated-orcid":true,"given":"Federico M.","family":"Asch","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute, Washington, DC (F.J.R.-W., M.C., F.M.A., A.S.)."},{"name":"Georgetown University, Washington, DC (F.J.R.-W., F.M.A., A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gaby","family":"Weissman","sequence":"additional","affiliation":[{"name":"Department of Cardiology (G.W.), MedStar Washington Hospital Center, Washington, DC."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8485-0058","authenticated-orcid":true,"given":"Anita","family":"Sadeghpour","sequence":"additional","affiliation":[{"name":"MedStar Health Research Institute, Washington, DC (F.J.R.-W., M.C., F.M.A., A.S.)."},{"name":"Georgetown University, Washington, DC (F.J.R.-W., F.M.A., A.S.)."}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian C.","family":"Schults","sequence":"additional","affiliation":[{"name":"Department of Cardiac 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