Impact of initial direction of Navitor transcatheter heart valve delivery system on final valve orientation and...

Data on the impact of the initial Navitor transcatheter heart valve (THV) deployment orientation on the final valve orientation in transcatheter aortic valve implantation (TAVI) assessed using post-implantation computed tomography (CT) is scarce. This study aimed to assess the impact of the initial deployment orientation of Navitor THV on the final orientation and neocommissural overlap with the coronary arteries. Additionally, the incidence of commissural misalignment (CMA) of Navitor THV and its impact on coronary access and short-term valve performance were evaluated. Post-TAVI CT was analysed in 77 patients. Severe coronary artery overlap with THV neocommissure was defined as 0°-20° apart. CMA was categorized by angle deviation from the native commissures: aligned (0°-15°), mild (15°-30°), moderate (30°-45°), and severe (45°-60°). The Navitor delivery system was introduced via the femoral artery with the lock button facing the 3, 6, 9, and 12 o'clock positions. Initial Navitor THV deployment orientation had no impact on the incidence of severe coronary artery overlap. Severe CMA was observed in 80.0% at 3 o'clock, 66.7% at 6 o'clock, 53.8% at 9 o'clock, and 42.2% at 12 o'clock position (p = 0.12). Severe CMA was not associated with the success rate of coronary cannulation after TAVI, short-term valve haemodynamics, or the incidence of hypoattenuated leaflet thickening. Initial Navitor THV orientation did not affect coronary artery overlap or CMA. Moreover, CMA of the Navitor THV did not affect coronary access or short-term valve performance.