Commissural Alignment and Coronary Access after Transcatheter Aortic Valve Replacement

Abstract

Transcatheter aortic valve implantation (TAVR) is the first therapeutic option for elderly patients with severe symptomatic aortic stenosis, and indications are steadily expanding to younger patients and subjects with lower surgical risk and longer life expectancy. Commissural alignment between native and transcatheter valves facilitates coronary access after TAVR and is thus considered a procedural goal, allowing long-term management of coronary artery disease. Moreover, commissural alignment may potentially have a positive impact on transvalvular hemodynamic and valve durability. This review focus on technical hints to achieve commissural alignment and current evidence for different transcatheter aortic valves.

Clinical Significance of Coronary Arterial Dominance: A Review of the Literature

“… 98 Preprocedural knowledge of coronary dominance may therefore be beneficial in risk analysis for complication of valvular repair, although this requires further evaluation and the role of coronary dominance in other structural procedures such as transcatheter aortic valve implantation remains unclear. 99 …”

Transcatheter Heart Valves—An Update on Types of Valves Available, Hardware Characteristics, and Patient Selection: An Indian Perspective

“…S3 has an outer skirt made up of PET fabric, which is designed to minimize PVL. S3 is available in four sizes (20,23,26, and 29 mm) and can treat annuli with area-derived diameters ranging from 18.6 to 29.5 mm.…”

“…21 Evolut, Acurate, and Navitor valve series have fluoroscopic markers to facilitate CA. 20 Octacore valve comes with the CrocoDial Compass crimper, which, along with aligners on the catheter shaft, aids in CA. Sapien and Myval valves do not have an established mechanism to achieve CA.…”

“…Mal-aligned THV implant is associated with severely compromised, or impossible, future coronary access. 19, 20 On the contrary, a high success rate can be expected in engaging the coronaries post-TAVI if CA is achieved. 21 Evolut, Acurate, and Navitor valve series have fluoroscopic markers to facilitate CA.…”