Portal de Periódicos da CAPES

Rationale, Definitions, Techniques, and Outcomes of Commissural Alignment in TAVR

2022; Elsevier BV; Volume: 15; Issue: 15 Linguagem: Inglês

10.1016/j.jcin.2022.06.001

1936-8798

Gilbert H.L. Tang, Ignacio J. Amat‐Santos, Ole De Backer, Marisa Avvedimento, Alfredo Redondo, Marco Barbanti, Giuliano Costa, Didier Tchetchè, Hélène Eltchaninoff, Won‐Keun Kim, Syed Zaid, Giuseppe Tarantini, Lars Søndergaard,

Aortic Disease and Treatment Approaches

Given the expanding indications of transcatheter aortic valve replacement (TAVR) in younger patients with longer life expectancies, the ability to perform postprocedural coronary access represents a priority in their lifetime management. A growing body of evidence suggests that commissural (and perhaps coronary) alignment in TAVR impacts coronary access and valve hemodynamics as well as coronary flow and access after redo-TAVR. Recent studies have provided modified delivery system insertion and rotation techniques to obtain commissural alignment with available transcatheter heart valve devices. Moreover, patient-specific preprocedural planning and postprocedural imaging tools have been developed to facilitate and evaluate commissural alignment. Future efforts should aim to refine transcatheter heart valve and delivery system designs to make neocommissural alignment easier and more reproducible. The aim of this review is to present an in-depth insight of commissural alignment in TAVR, including its rationale, standardized definitions, technical steps, outcomes, and future directions.