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Aortic Annulus S-Curve: Implications for Transcatheter Aortic Valve Replacement and Related Procedures, Part 1

Ali Zgheib1, Laurence Campens2, Ali Abualsaud3

  • 1McGill University Health Center, Glen Hospital, Department of Medicine, Division of Cardiology, Montreal, Quebec, Canada.

JACC. Cardiovascular Interventions
|December 8, 2022
PubMed

Insights

Understanding optimal fluoroscopic angles along the aortic annulus S-curve is crucial for transcatheter aortic valve replacement (TAVR) procedures. This knowledge enhances safety, efficacy, and reduces complications.

Area of Science:

  • Cardiovascular Imaging
  • Interventional Cardiology
  • Medical Device Technology

Background:

  • Transcatheter aortic valve replacement (TAVR) procedures require precise anatomical visualization.
  • Optimal fluoroscopic viewing angles are essential for various TAVR-related steps, including implantation depth and coronary access.
  • Current understanding of these angles along the aortic annulus S-curve can be improved.

Purpose of the Study:

  • To elucidate the importance of optimal fluoroscopic viewing angles along the aortic annulus S-curve for TAVR.
  • To enhance operator confidence and procedural outcomes in TAVR.
  • To identify strategies for reducing procedural risks and resource utilization.

Main Methods:

  • Analysis of fluoroscopic views relative to the aortic annulus S-curve.
  • Correlation of viewing angles with key procedural elements (e.g., implantation depth, commissural alignment, coronary access).
  • Evaluation of anatomical landmarks within the aortic annulus S-curve.

Main Results:

  • Optimal fluoroscopic angles are critical for assessing TAVR implantation depth and alignment.
  • Understanding the S-curve facilitates visualization of coronary anatomy and access.
  • Specific viewing angles provide clarity on bioprosthetic or native scallop interactions.

Conclusions:

  • Mastery of fluoroscopic angles along the aortic annulus S-curve improves TAVR safety and efficacy.
  • Enhanced understanding can lead to reduced procedural time, radiation, and contrast use.
  • Improved fluoroscopic guidance contributes to better patient outcomes and fewer complications.

Keywords:
BASILICAS-curvescommissural alignmentcoronary access post-TAVRoptimal projection curvesparavalvular leak closure

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