Accurate commissural alignment during ACURATE neo TAVI procedure. Proof of concept

Redondo, Alfredo; Valencia-Serrano, Félix; Santos‐Martínez, Sandra; Delgado-Arana, Jose Raúl; Barrero, Alejandro; Serrador, Ana; Gutiérrez, Hipólito; Sánchez-Lite, Israel; Sevilla, Teresa; Revilla, Ana; Baladrón, Carlos; Kim, Won-Keun; Carrasco-Moraleja, Manuel; Román, José Alberto San; Amat‐Santos, Ignacio J.

doi:10.1016/j.rec.2021.02.004

Cited by 10 publications

(20 citation statements)

References 15 publications

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“…Optimising transcatheter aortic valve commissural alignment in native annulus may avoid coronary artery overlap and facilitate coronary access in the future, especially using certain types of self-expandable transcatheter bioprostheses (Evolut from Medtronic and ACURATE-neo from Boston Scientific). [ 52 – 56 ] Redondo et al developed a promising method for proper commissural alignment (ACURATE-neo bioprosthesis) to insert the delivery system with a patient-specific rotation based on CT data analysis, tested in 3D, printed in silico models and in vivo. [ 56 ] The results suggested an important reduction in commissural misalignment and coronary artery overlap.…”

Section: Intervention In Tavi Patientsmentioning

confidence: 99%

“…[ 52 – 56 ] Redondo et al developed a promising method for proper commissural alignment (ACURATE-neo bioprosthesis) to insert the delivery system with a patient-specific rotation based on CT data analysis, tested in 3D, printed in silico models and in vivo. [ 56 ] The results suggested an important reduction in commissural misalignment and coronary artery overlap. [ 56 ]…”

Section: Intervention In Tavi Patientsmentioning

confidence: 99%

“…[ 56 ] The results suggested an important reduction in commissural misalignment and coronary artery overlap. [ 56 ]…”

Section: Intervention In Tavi Patientsmentioning

confidence: 99%

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Coronary Artery Disease in Patients with Aortic Stenosis and Transcatheter Aortic Valve Implantation: Implications for Management

Filho¹,

Accorsi

Ribeiro

2021

Eur Cardiol

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Aortic valve stenosis (AS) is the most common valvular heart disease among elderly patients. Since the pathophysiology of degenerative AS shares common pathways with atherosclerotic disease, the severity of AS in the elderly population is often concurrent to the presence of coronary artery disease (CAD). Although surgical aortic valve replacement has been the standard treatment for severe AS, the high operative morbidity and mortality in complex and fragile patients was the trigger to develop less invasive techniques. Transcatheter aortic valve implantation (TAVI) has been posed as the standard of care for elderly patients with severe AS with various risk profiles, which has meant that the concomitant management of CAD has become a crucial issue in such patients. Given the lack of randomised controlled trials evaluating the management of CAD in TAVI patients, most of the recommendations are based on retrospective cohort studies so that the Heart Team approach – together with an assessment of multiple parameters including symptoms and clinical characteristics, invasive and non-invasive ischaemic burden and anatomy – are crucial for the proper management of these patients. This article provides a review of current knowledge about assessment and therapeutic approaches for CAD and severe AS in patients undergoing TAVI.

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Section: Intervention In Tavi Patientsmentioning

confidence: 99%

Section: Intervention In Tavi Patientsmentioning

confidence: 99%

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Coronary Artery Disease in Patients with Aortic Stenosis and Transcatheter Aortic Valve Implantation: Implications for Management

Filho¹,

Accorsi

Ribeiro

2021

Eur Cardiol

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“…One such shortcoming is that commissural alignment of transcatheter heart valves (THV) appears to be random; meaning that the THV neo-commissures can misalign with the native commissures of the aortic valve during deployment or self-expansion ( 5 , 6 ). In contrast; bioprosthetic valves used in SAVR can be reliably aligned correctly; commissure-to-commissure with the native valve ( 7 ). In TAVR; the misalignment may result in the THV neo-commissures partially or fully overlapping the coronary artery ostia ( 5 , 6 ).…”

Section: Introductionmentioning

confidence: 99%

“…In TAVR; the misalignment may result in the THV neo-commissures partially or fully overlapping the coronary artery ostia ( 5 , 6 ). As a result; complications can arise if a younger patient needs a percutaneous coronary intervention or redo-TAVR especially since some of them will present with ischemic heart disease later in life ( 5 , 7 ). With commissural misalignment there is also an increased risk of a leak during diastole because of the unnatural orientation of the THV; this may add undue stress to the THV leaflets ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Commissural alignment in transcatheter aortic valve replacement: A literature review

Khalid

O’Sullivan

2022

Front. Cardiovasc. Med.

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IntroductionTranscatheter aortic valve replacement (TAVR) is a minimally invasive procedure to replace a diseased and faulty aortic valve in patients with severe aortic stenosis. As TAVR gains popularity among lower-risk younger patients with a longer life expectancy; there is a need to investigate the long-term shortcomings and limitations of the procedure for this patient group. One such shortcoming is that commissural alignment of transcatheter heart valves (THV) appears to be random; meaning that the THV neo-commissures can misalign with the native commissures of the aortic valve during deployment or self-expansion.ObjectivesIdentify techniques and procedures used to obtain commissural alignment in TAVR. Evaluate the effectiveness of these procedures in terms of the degree of commissural alignment. Analyse the impact of commissural alignment on coronary filling and re-access.MethodsTwo electronic online databases were searched to identify existing literature relevant to the aim and objectives of this review: EBSCOhost and PubMed. After search filters were applied and duplicates removed; a total of 64 articles from both databases were screened against the inclusion/exclusion criteria. This resulted in a total of thirteen articles which met the objectives of this review and thus; were included.ResultsAll studies focused on a patient centered approach involving pre-TAVR computed tomography to obtain commissural alignment. Other studies modified this approach and combined techniques. All studies that implemented a technique to reduce commissural misalignment were significantly successful in obtaining commissural alignment when compared to a study in which alignment was random when no technique was implemented. Severe coronary overlapping in commissural aligned heart valves was relatively low compared to severe coronary overlapping when no technique was implemented.ConclusionsAn increase in optimal commissural alignment via introduction of an alignment technique may seem attractive; however; the categorization of commissural alignment is arbitrary and does not accurately reflect real life clinical implications. Further research is needed to determine whether a routine procedure to achieve commissural alignment is necessary in low-risk younger patients undergoing TAVR.

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Effect of TAVR commissural alignment on coronary flow: A fluid-structure interaction analysis

Oks,

Houzeaux,

Vázquez

et al. 2023

Computer Methods and Programs in Biomedicine

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Accurate commissural alignment during ACURATE neo TAVI procedure. Proof of concept

Cited by 10 publications

References 15 publications

Coronary Artery Disease in Patients with Aortic Stenosis and Transcatheter Aortic Valve Implantation: Implications for Management

Coronary Artery Disease in Patients with Aortic Stenosis and Transcatheter Aortic Valve Implantation: Implications for Management

Commissural alignment in transcatheter aortic valve replacement: A literature review

Effect of TAVR commissural alignment on coronary flow: A fluid-structure interaction analysis

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