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. 2021 Jun 11;17(2):e152-e155.
doi: 10.4244/EIJ-D-20-01095.

Transcatheter aortic valve neo-commissure alignment with the Portico system

Ana Paula Tagliari  1 , Luca Vicentini, Jan Michael Zimmermann, Mizuki Miura, Enrico Ferrari, Daniel Perez, Philipp K Haager, Lucas Jörg, Francesco Maisano, Maurizio Taramasso
Affiliations

Transcatheter aortic valve neo-commissure alignment with the Portico system

Ana Paula Tagliari et al. EuroIntervention. .
No abstract available

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Conflict of interest statement

A.P. Tagliari reports a research grant from CAPES-Brasil (Finance Code 001). M. Miura reports being a consultant for Japan Lifeline. E. Ferrari reports being a consultant for Edwards and receiving research support/grants from Edwards, Medtronic and Somahlution. F. Maisano reports research support/grants from Abbott, Medtronic, Edwards, Biotronik, Boston, NVT and Terumo, and consulting fees/honoraria from Abbott, Medtronic, Edwards, SwissVortex, Perifect, Xeltis, Transseptal Solutions, Cardiovalve and Magenta, royalty income/IP rights from Edwards, and being a shareholder in CardioGard, Magenta, SwissVortex, Transseptal Solutions, 4Tech, and Perifect. M. Taramasso reports being a consultant for Abbott, Boston and 4Tech, and receiving consulting fees from Edwards, CoreMedic, SwissVortex and Mitraltech. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Steps to develop the different 3D models. A) Patient-specific CT scans were segmented using a free and open-source 3D Slicer software. The segmented aorta was exported as an STL 3D model and processed using the Meshmixer software (Autodesk, San Rafael, CA, USA). A shell was designed, representing the aortic wall. 3D models were printed on the Prusa I3 MK3 3D printer, with plastic filament polylactic acid material. Native commissures were marked using radiopaque markers and additional adapters were attached to the model. B) 3D models printed in different aorta angulations (horizontal, standard, anteriorised). C) Portico neo-commissure markers.
Figure 2
Figure 2
Neo-commissure alignment concept. Three native commissure markers were separately identified (A). A fluoroscopic projection depicting two native commissures in overlap in the inner aorta curve (IAC) and one isolated in the outer aorta curve (OAC) was set (B). Keeping this projection, the Portico delivery system was advanced to the descending thoracic aorta (C). The three neo-commissure markers were oriented similarly to the native ones (two in the IAC and one in the OAC) by rotating the delivery system clockwise until the desired position (red box) was achieved (D). This concept considers the premise that structures localised in the descending aorta’s medial aspect will be projected in the IAC once the delivery system is advanced (E). Standard fluoroscopic projection was resumed (avoiding parallax effect), the delivery system advanced (keeping the employed rotation), and the THV deployed as usual. At the end of the implant, the X-ray tube was rotated to check the final alignment in different projections (F). Final neo-commissure alignment evaluation in the benchtop model. Since the deviation between native commissures (black dots) and neo-commissures (red dots) was <15º, the implant was considered aligned (G).
See this image and copyright information in PMC

References

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