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NTVDM could have been ported to 64-bit Windows, but MSFT declined to do so. Leaked Windows source code shows it would have worked[0].

That would have given 16, 32, and 64 bit compatibility.

I don't get it. Would NTVDM have been better than say, using DOS-box?

Yes, because it's integrated far more closely with the system.

Yes, it would allow to create pipes between 16-bit NTVDM processes and native 64-bit processes.