Cleveland Clinic Partners With DASI Simulations to Advance AI Guidance in TAVR

Cleveland Clinic has partnered with the biomedical technology company DASI Simulations to validate the company’s Precision TAVI™ predictive modeling tool for simulating transcatheter aortic valve replacement (TAVR) procedures. A second stage of the collaboration involves co-development of a second-generation version of the tool for intraprocedural TAVR guidance.

By combining Cleveland Clinic’s extensive clinical data and expertise with DASI’s artificial intelligence (AI)-powered simulation models, the partnership seeks to elevate the standard of TAVR care and improve long-term patient outcomes.

“Artificial intelligence is becoming a very important tool for procedural planning in structural cardiology,” says Samir Kapadia, MD, Chair of Cardiovascular Medicine at Cleveland Clinic and an interventional cardiologist who has been instrumental in TAVR’s clinical evolution. “Our work with DASI Simulations is aimed at validating Precision TAVI’s use for TAVR planning and then breaking new ground by using AI for execution of the TAVR procedure rather than just procedural planning.”

Validation for use in TAVR planning

Precision TAVI, which received FDA clearance in 2023, transforms routine imaging, such as CT scans, into a three-dimensional predictive environment. This allows physicians to simulate various prosthetic valve sizes and types within a patient’s specific anatomy in advance of a TAVR procedure.

“High-quality imaging is the foundation of every successful structural heart intervention, and predictive simulation has the potential to further refine how we tailor procedures to individual patients,” notes Serge Harb, MD, of Cleveland Clinic’s Section of Cardiovascular Imaging. “By integrating detailed CT-derived anatomy with AI-driven modeling, Precision TAVI can help physicians better anticipate TAVR-related procedural challenges and optimize device selection and implantation strategy.”

While the software is already used by various centers across the nation, Cleveland Clinic’s initial role in the partnership involves a rigorous validation process at a high-volume expert center.

“We are currently using the software’s suggestions alongside our long-standing TAVR planning practices and measurements to assess for any differences,” Dr. Kapadia explains. He notes that this process, which began in late 2025 and is expected to last six months to a year, may result in recommendations on how the software’s outputs or data presentations might be adjusted for greater clinical utility.

Structural interventionalist Grant Reed, MD, MSc, is among the leading users of Precision TAVI for this validation exercise. “I continue to do my own measurements in planning TAVR cases, but I use the simulation as a confirmatory additional layer of support,” he says.

The value of predictive modeling

Dr. Reed notes that the value of predictive modeling lies in its ability to clarify complex anatomical relationships that are often difficult to visualize on standard CT reconstructions. He identifies the following as key clinical applications of the tool:

• Assessing coronary obstruction risk. The software delineates the specific relationship between aortic valve leaflets, the sinus dimensions and the coronary arteries. This is particularly useful when choosing between balloon-expandable and self-expanding valves in patients with borderline anatomy.
• Complex valve-in-valve planning. As patients live longer, "TAV-in-TAV" (placing a new TAVR valve inside an existing one) is becoming more common. Dr. Reed says the simulation allows physicians “to think two steps ahead,” ensuring that a current implantation does not preclude a successful future procedure.
• Gauging implantation depth and pacemaker risk. The technology helps visualize how the valve will interact with the conduction system. Physicians can individualize implantation depth — higher to reduce pacemaker risk or slightly deeper to preserve future coronary access.
• Calcium pattern visualization.The 3D simulations predict how specific calcium patterns will shift upon valve expansion, providing a window into how the anatomy will change after implantation.

“Predictive modeling is all about simplification and personalization of TAVR planning, as it offers recommendations tailored to each patient’s anatomy,” Dr. Reed says. “We now have a DASI report generated for all our TAVR patients, and we review those reports individually and then also collectively at our heart team meetings. There have been instances where the simulation has prompted us to change care for patients, particularly when weighing TAVR versus surgery in the context of trying to envision optimal lifetime management for a given patient.”

Image content: This image is available to view online.

View image online (https://assets.clevelandclinic.org/transform/c2a8393d-b9a5-4bed-9b46-d29d7b12f10f/precision-tavr-cqd-inset)

Examples of simulations generated by Precision TAVI for planning a basic TAVR procedure (left), a TAV-in-TAV procedure (middle) and a valve-in-valve TAVR procedure (right).

Democratizing structural heart excellence

Cleveland Clinic believes that refining the tool and expanding the scope of its use will help broadly optimize TAVR care, enabling lower-volume centers to better replicate the quality of higher-volume centers. The fact that Precision TAVI has a CMS reimbursement code for use in TAVR planning also supports its potential for more widespread adoption.

While the partnership with DASI Simulations is currently focused on the aortic valve, it could potentially expand to the broader landscape of structural heart disease. Future applications might include predictive modeling for mitral and tricuspid valve procedures, Dr. Kapadia says, to extend similar AI-driven guidance to some of the most complex challenges in valve disease.

“We look forward to deepening our experience with the DASI Precision TAVI modeling tool and learning how it can further contribute to procedural planning,” adds James Yun, MD, PhD, a Cleveland Clinic cardiothoracic surgeon with a specialty interest in TAVR. “The future potential for this and other AI tools to enhance both the planning and execution of both percutaneous and open surgical procedures is exciting.”

Disclosure. In addition to this partnership, Cleveland Clinic is an investor in DASI Simulations and may benefit financially from the sale of this technology.