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Published on: June 3, 2018
The Incidence, Impact, and Techniques of Commissural Alignment in Transcatheter Aortic Valve Implantation: A Review
Jose G Paredes-Vazquez1, Gabriela Tirado-Conte1, Asad Shabbir1
1Cardiovascular Institute, Hospital Clínico San Carlos, Instituto de Investigación Sanitaria del Hospital Clínico San Carlos (IdISSC), 28040 Madrid, Spain.
Insights
Commissural alignment of transcatheter heart valves (THV) in transcatheter aortic valve implantation (TAVI) is rarely achieved. Proper THV orientation is crucial for optimal leaflet function, coronary flow, and access to coronary ostia.
Area of Science:
- Cardiology
- Medical Devices
- Surgical Procedures
Background:
- Commissural alignment of transcatheter heart valves (THV) during transcatheter aortic valve implantation (TAVI) is not consistently achieved in clinical practice.
- The orientation of the THV within the aortic root significantly impacts leaflet hemodynamics, coronary blood flow, and accessibility of the coronary ostia.
- There is growing clinical interest in understanding and optimizing THV alignment.
Purpose of the Study:
- To review the incidence and clinical implications of commissural misalignment in TAVI.
- To provide detailed descriptions of techniques for achieving optimal commissural alignment with various contemporary THV devices.
Main Methods:
- Literature review focusing on commissural alignment in TAVI.
- Analysis of clinical outcomes related to THV orientation.
- Description of alignment strategies for different THV systems.
Main Results:
- Commissural misalignment is infrequently achieved during TAVI.
- Misalignment can negatively affect hemodynamic function, coronary perfusion, and procedural access.
- Specific techniques and device considerations can facilitate optimal commissural alignment.
Conclusions:
- Optimizing commissural alignment during TAVI is clinically significant.
- Understanding the implications of misalignment and employing appropriate techniques are essential for successful TAVI outcomes.
- Further research and device development may enhance alignment capabilities.
Abstract:
In current clinical practice, commissural alignment of the transcatheter heart valve (THV) during transcatheter aortic valve implantation (TAVI) is seldom achieved. Orientation of the THV within the aortic root and the subsequent influence upon leaflet haemodynamic function, coronary blood flow, and ease of access to the coronary ostia are gaining significant interest. Herein, we review the incidence and clinical implications of commissural misalignment in TAVI and offer thorough descriptions of how optimal alignment can be achieved with several different contemporary THV devices.
