TAVR has come a long way—from a high-risk bailout procedure to a precision-driven, patient-specific therapy.

In this MurmurMD case discussion, Dr. Matt Summers (Sentara Heart Valve Center) joins Dr. Aiden Raney to explore how new data, AI modeling, and simulation tools like DASI are transforming how interventionalists choose between self-expanding and balloon-expandable valves. A real look into contemporary approaches to valve therapy decisions.

Key insights covered:

• The evolution from procedural survival to lifetime valve strategy

• How hemodynamics and durability data are reshaping valve selection

• Using predictive modeling (DASI) to prevent annular rupture and coronary occlusion

• Real-world lessons from redo TAVR and valve-in-valve procedures

• Why commissural alignment and cusp overlap have changed the game

• What next-generation AI tools mean for precision TAVR planning

• How large-volume centers are integrating data, imaging, and simulation into every case

This conversation bridges clinical intuition with digital precision, offering a glimpse into how the next era of TAVR will be designed—patient by patient, model by model.

Chapters:

00:00 – Introduction and evolution of TAVR therapy

01:00 – From high-risk to precision: how TAVR decision-making has evolved

02:30 – Valve selection: BEV vs SEV and the 16 decision factors

04:00 – Durability, hemodynamics, and small annulus data

06:00 – What the SMART and Notion trials revealed about performance

08:00 – Coronary access, explant, and the penalty of being wrong

10:00 – AI modeling and pre-procedural simulation (DASI)

12:00 – Predicting rupture, occlusion, and leaflet modification needs

14:00 – Impact of modeling on procedural planning and outcomes

16:00 – Planning for the second valve: true lifetime management

18:00 – Future vision: Precision TAVR through AI-guided design

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