Digital twins and simulations in transcatheter coronary and structural heart interventions

Digital twin technology, which enables the creation of patient-specific virtual models, is increasingly applied in interventional cardiology to support personalized procedural planning and risk assessment. This review examines current applications of digital twins in coronary and structural heart interventions, including percutaneous coronary intervention (PCI), transcatheter aortic valve replacement (TAVR), transcatheter mitral valve replacement (TMVR), and left atrial appendage closure (LAAC). In coronary interventions, digital simulations based on computed tomography or angiography can estimate physiological indices, guide stent placement, and predict post-procedural hemodynamics. For structural interventions, simulation platforms generate 3D reconstructions from imaging data to model device-anatomy interactions, support valve sizing, and assess risks such as paravalvular leak or left ventricular outflow tract obstruction. Several tools are already integrated into clinical workflows, with growing evidence supporting their utility in improving planning accuracy and procedural outcomes. Nonetheless, broader adoption is limited by challenges related to model validation, data integration, workflow complexity, and regulatory constraints. In particular, validation remains difficult for procedures performed less frequently, such as TMVR. Ongoing developments in artificial intelligence and computational methods may enhance model speed and accuracy, enabling wider and more efficient clinical use. Digital twin technologies represent a promising direction for advancing precision medicine in transcatheter coronary and structural heart interventions.