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Computed tomography simulation predicted that the position of the pinned THV leaflets would hinder future coronary access in up to 78% of patients after TAVR-in-TAVR. Further THV design improvements and leaflet modification strategies are needed to mitigate the risk of coronary obstruction during TAVR-in-TAVR with self-expanding THVs and to facilitate future coronary access. Registration URL https//www.clinicaltrials.gov. Unique identifier NCT03423459. Further THV design improvements and leaflet modification strategies are needed to miti
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