Annular-to-Apical "Emory Angle" to Ensure Coaxial Mitral Implantation of the SAPIEN 3 Valve.

Paravalvular leak (PVL) remains a key limitation of transseptal transcatheter mitral valve replacement (TMVR) using the SAPIEN 3 valve (Edwards Lifesciences, Irvine, California), especially in prior surgical rings (VIR) or mitral annular calcification (VIM) ([1][1],[2][2]). PVL often results from