(A) Current clinical approach to paravalvular leak closure: (1) Catheter approaches valve. (2) Wire is extended from catheter to locate leak. (3) Vascular occluder is deployed inside leak channel. While transapical access is illustrated, approaching the valve from the aorta via transfemoral access is common. (B) Robotic catheter in operating room. Graphical interface displays catheter tip view and geometric model of robot and valve annulus. (C) Two views of bioprosthetic aortic valve designed to produce 3 paravalvular leaks at 2, 6 and 10 o’clock positions. Blue sutures are used to detect tangent to annulus. Green sutures are used to estimate valve rotation with respect to robot. (D) Vascular occluder (AMPLATZER Vascular Plug II, St. Jude Medical, Saint Paul, MN) used to plug leaks.