Conventional versus modified delivery system technique in commissural alignment from the Evolut low-risk CT substudy

Area of Science:

• Cardiovascular Surgery
• Medical Devices
• Imaging Technology

Background:

• Commissural alignment during transcatheter aortic valve replacement (TAVR) is inconsistent, unlike surgical aortic valve replacement.
• Inconsistent alignment can hinder coronary access and reintervention after TAVR.

Purpose of the Study:

• To evaluate the impact of a modified delivery system (DS) insertion technique on Evolut valve "Hat-marker" orientation and commissural alignment.
• To compare the modified technique against the conventional DS insertion technique in TAVR patients.

Main Methods:

• Assessed "Hat-marker" orientations (outer curve, center front) and coronary artery (CA) overlap in TAVR patients from the Evolut Low Risk Trial CT substudy.
• Compared outcomes between a conventional DS technique (flush port at 12 o'clock) and a modified technique (3-o'clock flush port).

Main Results:

• The modified DS technique resulted in higher rates of favorable "Hat-marker" orientation (outer curve/center front).
• Improved commissural alignment was observed with the modified technique.
• Significantly reduced severe coronary artery overlap was achieved with the modified technique compared to the conventional method (e.g., 20.8% vs. 41.6% for one or both CAs).

Conclusions:

• The modified delivery system insertion technique enhances initial "Hat-marker" orientation during Evolut valve deployment.
• This improved orientation leads to better commissural alignment and reduced coronary artery overlap post-TAVR.