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Patient-Specific Implantation Technique to Obtain Neo-Commissural Alignment With Self-Expanding Transcatheter Aortic Valves

Research output: Contribution to journalJournal articleResearchpeer-review

  1. Striving for Perfection in Transcatheter LAA Closure: One Step Closer With Newer-Generation Devices

    Research output: Contribution to journalComment/debateResearchpeer-review

  2. Comparison of Predicted and Confirmed Neo-Left Ventricular Outflow Tract After Transcatheter Mitral Valve Replacement

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Outcomes of Patients With Hypertrophic Obstructive Cardiomyopathy and Pacemaker Implanted After Alcohol Septal Ablation

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  4. Management and Outcome of Acute Ischemic Stroke Complicating Transcatheter Aortic Valve Replacement

    Research output: Contribution to journalJournal articleResearchpeer-review

  5. Measuring Transvalvular Aortic Pressure Gradients: Answering Questions or Asking New Ones?

    Research output: Contribution to journalEditorialResearchpeer-review

  1. Striving for Perfection in Transcatheter LAA Closure: One Step Closer With Newer-Generation Devices

    Research output: Contribution to journalComment/debateResearchpeer-review

  2. Facilitation techniques to cross the interatrial septum with intracardiac echocardiography during left atrial appendage closure

    Research output: Contribution to journalJournal articleResearchpeer-review

  3. Comparison of Predicted and Confirmed Neo-Left Ventricular Outflow Tract After Transcatheter Mitral Valve Replacement

    Research output: Contribution to journalJournal articleResearchpeer-review

  4. Is transcatheter aortic valve implantation safe in patients with left ventricular outflow tract calcification?

    Research output: Contribution to journalEditorialResearchpeer-review

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OBJECTIVES: The authors sought to investigate whether a patient-specific implantation technique during transcatheter aortic valve replacement (TAVR) can result in a safe and reproducible neo-commissural alignment of self-expanding transcatheter heart valves (THVs).

BACKGROUND: To date, little attention has been paid to neo-commissural alignment during TAVR.

METHODS: A fluoroscopy-based, patient- and valve-specific TAVR implantation technique was applied in 60 patients treated with 3 different self-expanding THV platforms (Evolut R/PRO, Medtronic; ACURATE neo2, Boston Scientific; and Portico, Abbott-20 patients in each group). Post-TAVR cardiac computed tomography was used to assess THV neo-commissural alignment.

RESULTS: Considering all 60 patients, ≤mild commissural misalignment (CMA <30°) was obtained in 53 patients (88%) using this modified TAVR implantation technique-in 36 patients (60%), optimal commissural alignment (<15°) was obtained. In 2 patients, cardiac computed tomography revealed severe CMA (>45°) with overlap between the coronary ostia and THV commissures. Using the ACURATE neo2 platform, operators succeeded in avoiding ≥moderate CMA in all 20 cases. When analyzing those cases in which the optimal amount of THV rotation could be assessed and applied before THV expansion (n = 52; 87%), the success rate of TAVR with ≤mild CMA was 98%. No procedure- or valve-related complications occurred in this study cohort.

CONCLUSIONS: A patient-specific TAVR implantation technique aiming to obtain neo-commissural alignment is feasible and safe, and aides to prevent THV implantations with overlap between the coronary ostia and THV commissures. Optimized TAVR devices and design may further improve the success rate of TAVR with neo-commissural alignment.

Original languageEnglish
JournalJACC: Cardiovascular Interventions
Volume14
Issue number19
Pages (from-to)2097-2108
Number of pages12
ISSN1936-8798
DOIs
Publication statusPublished - 11 Oct 2021

Bibliographical note

Copyright © 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

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