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. 2021 Oct 11;14(19):2097-2108.
doi: 10.1016/j.jcin.2021.06.033. Epub 2021 Sep 15.

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

Gintautas Bieliauskas  1 , Ivan Wong  1 , Vilhelmas Bajoras  1 , Xi Wang  1 , Klaus Fuglsang Kofoed  1 , Ole De Backer  2 , Lars Søndergaard  1
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Free article

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

Gintautas Bieliauskas et al. JACC Cardiovasc Interv. .
Free article

Abstract

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.

Keywords: TAVR; cardiac computed tomography; commissural alignment; implantation technique; patient-specific.

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Conflict of interest statement

Funding Support and Author Disclosures Dr Bieliauskas has received consulting fees from Abbott, Boston Scientific, and Medtronic. Dr Kofoed has received institutional grants from AP Møller og hustru Chastine McKinney Møllers Fond, The Meyer Foundation, The Danish Heart Foundation, The Danish Agency for Science, Technology and Innovation by The Danish Council for Strategic Research and Canon Medical Corporation. Dr De Backer has received institutional research grants and consulting fees from Abbott and Boston Scientific. Dr Søndergaard has received institutional research grants and consulting fees from Abbott, Boston Scientific, and Medtronic. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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