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Patient-Specific Strategy for Coronary Alignment in TAVI With Evolut FX.

Michele Galasso1,2, Greta Cattaneo2,3, Fabio Casamassima4

  • 1School of Medicine and Surgery, Milano-Bicocca University, Milan, Italy.

Catheterization and Cardiovascular Interventions : Official Journal of the Society for Cardiac Angiography & Interventions
|December 30, 2025
PubMed
Summary
This summary is machine-generated.

This study introduces a new CT and fluoroscopy-guided method to improve coronary artery alignment during transcatheter aortic valve implantation (TAVI). The technique aims to preserve future coronary access by optimizing valve positioning.

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Area of Science:

  • Cardiovascular Medicine
  • Medical Imaging
  • Interventional Cardiology

Background:

  • Coronary access after transcatheter aortic valve implantation (TAVI) is crucial for future interventions but challenging due to anatomical variability.
  • Current TAVI guidance relies on 2D fluoroscopy, often failing to ensure optimal coronary ostial alignment despite achieving commissural alignment.

Purpose of the Study:

  • To describe a patient-specific strategy using CT and fluoroscopy to optimize coronary alignment during TAVI with the Evolut FX+ platform.
  • To enhance procedural control and preserve coronary access for patients undergoing TAVI.

Main Methods:

  • A pre-procedural CT analysis assessed coronary ostial position, intercoronary angles, and valve geometry.
  • A customized fluoroscopic view, the Coronary Customized Projection, was identified for guiding valve deployment.
  • This projection facilitated mono-coronary or bi-coronary alignment based on individual anatomy.

Main Results:

  • The described strategy integrates detailed pre-procedural imaging with a specific fluoroscopic view for valve implantation.
  • It allows for patient-specific optimization of valve orientation to align with coronary ostia.
  • The approach aims to maintain procedural simplicity while improving coronary access preservation.

Conclusions:

  • A patient-specific, CT- and fluoroscopy-guided strategy can optimize coronary alignment during TAVI.
  • This method enhances procedural control and aims to preserve future coronary access.
  • Further prospective studies are needed to confirm the impact on coronary reaccess and long-term outcomes.