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.
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.
Authors: Helge Mollmann; Axel Linke; Luis Nombela-Franco; Martin Sluka; Juan Francisco Oteo Dominguez; Matteo Montorfano; Won-Keun Kim; Martin Arnold; Mariuca Vasa-Nicotera; Lenard Conradi; Anthony Camuglia; Francesco Bedogni; Ganesh Manoharan Journal: J Clin Med Date: 2022-08-18 Impact factor: 4.964
Authors: Arif A Khokhar; Francesco Ponticelli; Adriana Zlahoda-Huzior; Kailash Chandra; Rossella Ruggiero; Marco Toselli; Francesco Gallo; Alberto Cereda; Alessandro Sticchi; Alessandra Laricchia; Damiano Regazzoli; Antonio Mangieri; Bernhard Reimers; Simone Biscaglia; Carlo Tumscitz; Gianluca Campo; Ghada W Mikhail; Won-Keun Kim; Antonio Colombo; Dariusz Dudek; Francesco Giannini Journal: Front Cardiovasc Med Date: 2022-09-14
Authors: Francesco Soriano; Claudio Montalto; Dario Calderone; Stefano Nava; Giuseppe Esposito; Francesco Saia; Jacopo A Oreglia; Lars Søndergaard Journal: Eur Heart J Case Rep Date: 2022-09-26