Leaflet Modification to Mitigate Coronary Obstruction Risk During TAVR
Issued Date
2026-06-22
Resource Type
ISSN
19368798
eISSN
18767605
Scopus ID
2-s2.0-105041683011
Journal Title
Jacc Cardiovascular Interventions
Volume
19
Issue
12
Start Page
1639
End Page
1649
Rights Holder(s)
SCOPUS
Bibliographic Citation
Jacc Cardiovascular Interventions Vol.19 No.12 (2026) , 1639-1649
Suggested Citation
Occhipinti G., Laudani C., Jabri A., Pensotti F., Leone P.P., Khokhar A.A., Genereux P., Beneduce A., Wongpraparut N., Mangieri A., Serra V., Nombela-Franco L., Sanchez J.S., Asmarats L., Teles R.C., Chandavimol M., Romaguera R., Akodad M., Cuisset T., Tayal R., Algethami A.R., Díaz J.F., Laffond A., Martin P., Perez L., Ruiz-Quevedo V., Sarno G., Vázquez Álvarez M.E., Assafin M., García-Gómez M., Ruberti A., Sanchis L., Freixa X., Maisano F., Buzzatti N., Giustino G., De Backer O., Latib A., Amat-Santos I.J., Villablanca P.A., Regueiro A. Leaflet Modification to Mitigate Coronary Obstruction Risk During TAVR. Jacc Cardiovascular Interventions Vol.19 No.12 (2026) , 1639-1649. 1649. doi:10.1016/j.jcin.2026.05.011 Retrieved from: https://repository.li.mahidol.ac.th/handle/123456789/117424
Title
Leaflet Modification to Mitigate Coronary Obstruction Risk During TAVR
Author(s)
Occhipinti G.
Laudani C.
Jabri A.
Pensotti F.
Leone P.P.
Khokhar A.A.
Genereux P.
Beneduce A.
Wongpraparut N.
Mangieri A.
Serra V.
Nombela-Franco L.
Sanchez J.S.
Asmarats L.
Teles R.C.
Chandavimol M.
Romaguera R.
Akodad M.
Cuisset T.
Tayal R.
Algethami A.R.
Díaz J.F.
Laffond A.
Martin P.
Perez L.
Ruiz-Quevedo V.
Sarno G.
Vázquez Álvarez M.E.
Assafin M.
García-Gómez M.
Ruberti A.
Sanchis L.
Freixa X.
Maisano F.
Buzzatti N.
Giustino G.
De Backer O.
Latib A.
Amat-Santos I.J.
Villablanca P.A.
Regueiro A.
Laudani C.
Jabri A.
Pensotti F.
Leone P.P.
Khokhar A.A.
Genereux P.
Beneduce A.
Wongpraparut N.
Mangieri A.
Serra V.
Nombela-Franco L.
Sanchez J.S.
Asmarats L.
Teles R.C.
Chandavimol M.
Romaguera R.
Akodad M.
Cuisset T.
Tayal R.
Algethami A.R.
Díaz J.F.
Laffond A.
Martin P.
Perez L.
Ruiz-Quevedo V.
Sarno G.
Vázquez Álvarez M.E.
Assafin M.
García-Gómez M.
Ruberti A.
Sanchis L.
Freixa X.
Maisano F.
Buzzatti N.
Giustino G.
De Backer O.
Latib A.
Amat-Santos I.J.
Villablanca P.A.
Regueiro A.
Author's Affiliation
Inserm
Københavns Universitet
Uppsala Universitet
Universitat de Barcelona
Rigshospitalet
University of Florida College of Medicine
Montefiore Medical Center
Institut d'Investigacions Biomèdiques August Pi i Sunyer - IDIBAPS
San Raffaele Scientific Institute
Hospital Clínico San Carlos
Hospital General Universitario Gregorio Marañón
Hospital de La Santa Creu I Sant Pau
Hopital La Timone
Henry Ford Hospital
Humanitas Research Hospital
Hospital Universitari i Politècnic La Fe
Hospital Universitario Virgen del Rocío
Hospital Universitari de Bellvitge
Siriraj Hospital
Institut d'Investigació Biomedica de Bellvitge
Hospital Universitario de Navarra
Centro de Investigación en Red en Enfermedades Cardiovasculares
Ramathibodi Hospital
Hospital Clínico Universitario de Valladolid
Hospital Universitario de Canarias
King Abdulaziz Medical City - Riyadh
Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco"
Uppsala Clinical Research Center
Hospital de Santa Cruz, Carnaxide
Complejo Asistencial Universitario de Salamanca
ICPS Institut CardioVasculaire Paris-Sud
Hospital Clínico Regional de Concepción Dr. Guillermo Grant Benavente
Hospital Universitario Vall d’Hebron
Morristown Medical Center
White Plains Hospital Center
Valley Health System
Cardiovascular Institute
Københavns Universitet
Uppsala Universitet
Universitat de Barcelona
Rigshospitalet
University of Florida College of Medicine
Montefiore Medical Center
Institut d'Investigacions Biomèdiques August Pi i Sunyer - IDIBAPS
San Raffaele Scientific Institute
Hospital Clínico San Carlos
Hospital General Universitario Gregorio Marañón
Hospital de La Santa Creu I Sant Pau
Hopital La Timone
Henry Ford Hospital
Humanitas Research Hospital
Hospital Universitari i Politècnic La Fe
Hospital Universitario Virgen del Rocío
Hospital Universitari de Bellvitge
Siriraj Hospital
Institut d'Investigació Biomedica de Bellvitge
Hospital Universitario de Navarra
Centro de Investigación en Red en Enfermedades Cardiovasculares
Ramathibodi Hospital
Hospital Clínico Universitario de Valladolid
Hospital Universitario de Canarias
King Abdulaziz Medical City - Riyadh
Azienda Ospedaliero Universitaria Policlinico "G.Rodolico - San Marco"
Uppsala Clinical Research Center
Hospital de Santa Cruz, Carnaxide
Complejo Asistencial Universitario de Salamanca
ICPS Institut CardioVasculaire Paris-Sud
Hospital Clínico Regional de Concepción Dr. Guillermo Grant Benavente
Hospital Universitario Vall d’Hebron
Morristown Medical Center
White Plains Hospital Center
Valley Health System
Cardiovascular Institute
Corresponding Author(s)
Other Contributor(s)
Abstract
Background Coronary obstruction (CO) is a rare but life-threatening complication of transcatheter aortic valve replacement (TAVR). Leaflet modification techniques have been developed to mitigate this risk; however, real-world evidence remains scarce. Objectives The aim of this study was to report procedural and 30-day outcomes of patients at high risk for CO undergoing leaflet modification. Methods LOFTER-TAVR (Leaflet mOdiFication Techniques to prEvent coRonary obstruction risk during Transcatheter Aortic Valve Replacement) was an international, multicenter registry of consecutive patients undergoing leaflet modification before TAVR (September 2019 to January 2026). Coprimary endpoints were leaflet modification–directed technical success and Valve Academic Research Consortium 3 (VARC-3) technical success. Secondary endpoints included in-hospital and 30-day outcomes. Results A total of 293 patients underwent leaflet modification, including 202 (68.9%) through a leaflet-splitting approach and 91 (31.1%) through an intraleaflet disruption approach. Overall, 139 of 293 (47.4%) treated valves were natives. Successful leaflet traversal occurred in 310 of 318 leaflets (97.5%; 95% CI: 94.9%-98.9%) and successful leaflet modification in 306 of 318 leaflets (96.2%; 95% CI: 93.3%-97.9%). Leaflet modification–directed technical success was achieved in 251 of 293 patients (85.7%; 95% CI: 81.0%-89.4%) and VARC-3 technical success in 254 of 293 patients (86.7%; 95% CI: 82.1%-90.3%). Notably, 91.1% (95% CI: 87.1%-94.0%) of patients underwent TAVR without CO events. Delayed CO occurred in 3 of 293 patients (1.0%; 95% CI: 0.3%-3.0%). The median follow-up duration was 100 days (Q1-Q3: 30-443 days). At 30 days, freedom from VARC-3 early safety was achieved in 181 of 293 patients (61.8%; 95% CI: 56.5%-67.6%). Conclusions Leaflet modification techniques demonstrated high technical feasibility across a broad anatomical spectrum but carried considerable early clinical risk. These findings support its role as an adjunctive strategy for selected patients undergoing TAVR, although in the context of careful preprocedural planning and a structured multidisciplinary approach.