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Transcatheter heart valve commissural alignment: an updated review
Mariama Akodad1, Youcef Lounes2, David Meier3
1Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Interventional Cardiology Department, Massy, France.
Frontiers in Cardiovascular Medicine
|May 8, 2023
Summary
Commissural alignment (CA) is crucial for transcatheter aortic valve replacement (TAVR) in longer-living patients. Optimizing CA during TAVR improves valve function, future access, and procedure repeatability, enhancing patient outcomes.
Area of Science:
- Cardiology
- Medical Devices
- Interventional Cardiology
Background:
- Transcatheter aortic valve replacement (TAVR) indications now include lower-risk patients with longer life expectancies.
- Commissural alignment (CA) is an emerging cornerstone for TAVR in patients with increased longevity.
- Proper CA may enhance transcatheter heart valve (THV) hemodynamics, future coronary access, and procedural repeatability.
Purpose of the Study:
- To review the assessment methods and techniques for optimizing commissural alignment (CA) during transcatheter aortic valve replacement (TAVR).
- To discuss the clinical impact of commissural misalignment and challenging scenarios in TAVR procedures.
- To provide an overview of current progress in achieving CA with various THV platforms.
Main Methods:
- Standardized definition of CA using a four-tier scale based on computed tomography (CT) analysis by the ALIGN-TAVR consortium.
- Techniques for optimizing CA during the index TAVR procedure, including specific delivery catheter orientation and THV rotation.
- Utilizing CT-derived views to achieve reasonable CA during TAVR procedures with self-expandable platforms.
Main Results:
- Feasibility and safety of CA optimization techniques have been demonstrated.
- Significant reduction in coronary overlap has been observed using these alignment methods.
- Progress has been made in optimizing CA, particularly with self-expandable THV platforms.
Conclusions:
- Commissural alignment is a key consideration for TAVR in patients with longer life expectancy.
- Current techniques allow for feasible and safe optimization of CA during TAVR.
- Further understanding and application of CA techniques can improve TAVR outcomes and patient management.
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