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Commissural and coronary alignment of the Venus-A valve after transcatheter aortic valve replacement: a retrospective

Siyu Xi1, Haishan Zhang1, Yuan Gao1

  • 1Department of Cardiology, The First Hospital of China Medical University, Shenyang, China.

Cardiovascular Diagnosis and Therapy
|July 5, 2023
PubMed

Insights

Transcatheter aortic valve replacement (TAVR) with the Venus-A valve using a standard technique did not achieve commissural or coronary alignment. Further methods are needed to optimize Venus-A valve positioning for improved patient outcomes.

Area of Science:

  • Cardiovascular Medicine
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Neo-commissural orientation of transcatheter heart valves (THV) impacts coronary obstruction, THV durability, and future coronary access post-TAVR.
  • Specific orientations for Evolut R/Pro and Acurate Neo valves are known to improve commissural alignment.
  • Methods for achieving commissural alignment with the Venus-A valve are not established.

Purpose of the Study:

  • To evaluate commissural and coronary alignment of the Venus-A self-expanding valve after TAVR.
  • To assess alignment using a standard system delivery technique.

Main Methods:

  • Retrospective cross-sectional study of 45 TAVR patients.
  • Analysis of pre- and post-procedural CT scans.
  • Categorization of commissural misalignment (CMA) and coronary overlap (CO) based on defined angle deviations.

Main Results:

  • Significant commissural misalignment observed: 20.0% aligned, 33.3% mild CMA, 26.7% moderate CMA, 20.0% severe CMA.
  • High incidence of coronary overlap: 24.4% severe CO with left main, 28.9% with right coronary artery.
  • 46.7% of patients experienced coronary overlap with one or both coronary arteries.

Conclusions:

  • Standard delivery technique for Venus-A valve does not achieve commissural or coronary alignment.
  • New strategies are required to optimize Venus-A valve positioning and alignment.
Abstract

Keywords:
Commissural alignmentVenus-A self-expanding valvecoronary alignmenttranscatheter aortic valve replacement (TAVR)

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