Precision TAVR quantification— AI-accelerated TAVR planning reduces assessment time by 80% in bicuspid aortic stenosis

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Yu Mao, Yang Liu, Mengen Zhai, Ping Jin, Wenjing Li, Xinglong Dong, Fangyao Chen, Xiaodong Wang, Yanchi Wang, Gejun Zhang, Hongxin Li, Yining Yang, Haibo Zhang, Jian Liu, Yingqiang Guo, Yongjian Wu, Yidan Xue, Junpeng Zhang, Alejandro Frangi, Jian Yang

Published: 05 Dec 2025, Last Modified: 22 Jan 2026European Heart Journal - Imaging Methods and PracticeEveryoneRevisionsBibTeXCC BY-SA 4.0
Abstract: AIMS: Bicuspid aortic valve (BAV) stenosis complicates transcatheter aortic valve replacement (TAVR) planning, with no validated automated measurement algorithm available. We developed Cardioverse, the first fully automated deep learning algorithm for BAV anatomical assessment in TAVR planning. METHODS AND RESULTS: We conducted a large-scale, multicenter retrospective study encompassing 1,147 consecutive patients with BAV undergoing TAVR across 16 high-volume Chinese centers (March 2019-February 2023). Cardioverse was trained on this cohort and evaluated in an internal ( n = 437) and external ( n = 110) validation cohorts. Our novel Cardioverse algorithm demonstrated exceptional segmentation performance across all anatomical targets with Dice similarity coefficients >0.97 for coronary cusps and ostia. Critically, the algorithm achieved unprecedented workflow efficiency gains: 80% reduction in assessment time [241.0 IQR (181.0, 297.0) vs. 1251.0 IQR (872.0, 1408.0) seconds], 85% reduction in user interactions [57.0 IQR (45.0, 78.0) vs. 382.5 IQR (285.5, 475.0) clicks], and 87% reduction in manual effort [7.5 IQR (4.8, 9.3) vs. 57.2 IQR (43.5, 68.4) meters mouse movement] compared to expert observers ( P < 0.001). Importantly, accuracy was maintained across all BAV phenotypes with correlation coefficients >0.91 for all critical measurements, including annular dimensions, calcification quantification, and aortic root morphology assessment. CONCLUSION: Cardioverse transforms pre-TAVR assessment for BAV patients, offering a validated solution combining accuracy and efficiency. It reduces assessment time from over 20 min to < 5 min, addressing the need for standardized, rapid, and reliable BAV evaluation. Its robust performance across diverse BAV phenotypes makes it a crucial tool for enhancing TAVR planning consistency. CLINICAL TRIAL REGISTRATION: ClinicalTrials.gov Protocol Registration System (NCT05044338).