Commissural and Coronary Alignment Strategies in Transcatheter Aortic Valve Replacement: Success Rate and Risks

Commissural alignment (CA) is becoming increasingly important in the lifetime management of younger patients with aortic stenosis undergoing transcatheter aortic valve implantation, potentially influencing coronary access, valve-in-valve feasibility and haemodynamics. Interest in the topic has led to a growing body of evidence, valve design improvements and optimised implantation techniques. In this review, we summarise the clinical impact of CA, its success rate and limitations, stressing the potential role of coronary alignment as opposed to CA. We also describe the techniques to achieve CA with the latest iterations of the most used transcatheter aortic valve implantation devices.