Accurate intraoperative delineation of the aortic root and localization of key
anatomical landmarks during transcatheter aortic valve implantation (TAVI)
remain difficult because fluoroscopy provides low soft-tissue contrast and is
frequently degraded by motion and overlap from catheters and delivery
systems. This study developed and validated a multitask deep learning model
for simultaneous aortic root segmentation and landmark localization on
fluoroscopic images to support image-guided TAVI. A retrospective dataset of
2,895 fully anonymized fluoroscopic frames from 83 patients who underwent
TAVI between 2018 and 2024 was used. Expert annotations included binary
masks of the contrast-enhanced aortic root and four anatomical landmarks:
two aortic annulus points (AA1, AA2) and two sinotubular junction points near
the coronary ostia (STJ1, STJ2). We developed BoundaryAwareMANet
(BAMNet), a multitask architecture combining an EfficientNet-V2 encoder, an
MA-Net-inspired decoder, a coordinate-aware landmark head, and an
auxiliary boundary-guidance pathway. Model performance was evaluated
using patient-level five-fold cross-validation. Across five folds, BAMNet
achieved Dice 0.916+0.011, IoU 0.850+0.018, and Surface Dice@4 mm
0.845+0.031. Landmark localization reached median and mean errors of
7.64+0.33 px and 10.02+0.17 px, corresponding to fold-weighted
millimeter errors of 2.03 mm and 2.66 mm after image-specific pixel-spacing
conversion. The model produced both segmentation masks and landmark
coordinates in a single forward pass, maintaining real-time inference at
approximately 63 FPS. Joint segmentation of the aortic root and localization
of anatomical landmarks on intraoperative fluoroscopy is feasible.