Coronary Access After Transcatheter Aortic Valve Replacement With Commissural Alignment: The ALIGN-ACCESS Study

Tarantini, Giuseppe; Fovino, Luca Nai; Scotti, Andrea; Massussi, Mauro; Cardaioli, Francesco; Rodinò, Giulio; Benedetti, A.; Boiago, Mauro; Matsuda, Yuji; Continisio, Saverio; Montonati, Carolina; Cacciavillani, Luisa; Pavei, Andrea; Masiero, Giulia; Napodano, Massimo; Fraccaro, Chiara; Fabris, Tommaso; Iliceto, Sabino

doi:10.1161/circinterventions.121.011045

Cited by 86 publications

(56 citation statements)

References 28 publications

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“…Besides, coronary access availability is another concern when using the COP technique to implant prosthesis higher ( 31 ). The method used to achieve commissure alignment during TAVR is another new technique, intended to make coronary ostia more easily available ( 32 – 34 ). In the SAVR procedure, surgeons can directly see coronary ostia and align the bioprosthesis with native valve commissures.…”

Section: Discussionmentioning

confidence: 99%

Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis

Chen

Zhu

Liu

et al. 2022

Front. Cardiovasc. Med.

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ObjectivePermanent pacemaker implantation (PPI) is a common complication after transcatheter aortic valve replacement (TAVR). Recently, the cusp-overlap projection (COP) technique was thought to be a feasible method to reduce PPI risk. However, the evidence is still relatively scarce. Therefore, this meta-analysis was performed to compare COP and standard three-cusp coplanar (TCC) projection technique.MethodsPubMed and EMBASE databases were systematically searched for relevant literature published from the inception (EMBASE from 1974 and PubMed from 1966) to 16 April 2022, following the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. The primary outcome of interest was post-operative (including in-hospital and 30-day) PPI.ResultsTotal of 3,647 subjects from 11 studies were included in this meta-analysis. Of those, 1,453 underwent self-expanding TAVR using COP and 2,194 using TCC technique. In a pooled analysis, the cumulative PPI incidence was 9.3% [95% confidence interval (CI): 6.9–11.7%] and 18.9% (95% CI: 15.5–22.3%) in the COP group and TCC group, respectively. The application of the COP technique was associated with a significant PPI risk reduction (I2 = 40.3% and heterogeneity Chi-square p = 0.070, random-effects OR: 0.49, 95% CI: 0.36–0.66, p < 0.001). A higher implantation depth was achieved in the COP group compared with the TCC group [standardized mean difference (SMD) = −0.324, 95% CI: (−0.469, −0.180)]. There was no significant difference between the two groups in second valve implantation, prosthesis pop-out, fluoroscopic time, post-operative left bundle branch block, mortality, stroke, moderate/severe paravalvular leakage, mean gradient, and length of hospital stay. However, radiation doses were higher in the COP group [SMD = 0.394, 95% CI: (0.216, 0.572), p < 0.001].ConclusionIn self-expanding TAVR, the application of the cusp overlap projection technique was associated with a lower risk of PPI compared with the standard TCC technique.Systematic review registration[https://inplasy.com/inplasy-2022-4-0092/], identifier [INPLASY202240092].

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Section: Discussionmentioning

confidence: 99%

Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis

Chen

Zhu

Liu

et al. 2022

Front. Cardiovasc. Med.

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“…Comparisons between commissural alignment achieved in the different THV platforms were drawn in a few studies and the results from Ochiai et al ( 10 ) and Tarantini et al ( 17 ) may indicate that the SAPIEN 3 platform is favorable to commissural alignment and subsequent coronary access as patients receiving this platform had considerably lower percentages of unfavorable coronary access. For example; when compared to the Evolut and Acurate Neo platforms; coronary access was higher in SAPIEN 3 than both Evolut and Neo THVs regardless of whether they were aligned or misaligned (95% vs. 71% and 46%; respectively).…”

Section: Discussionmentioning

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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“…34 Other factors, such as low sinus of Valsalva and a high THV-sinus of Valsalva relationship, were found to be predictive of impaired coronary access after TAVR. 35 These technical and anatomical features are important for the heart team to consider when making decisions regarding therapeutic and prosthesis selection in younger patients with a longer life expectancy.…”

Section: Issues With Tavr In Young Low-risk Patientsmentioning

confidence: 99%

Transcatheter Versus Surgical Aortic Valve Replacement in Young, Low-risk Patients with Severe Aortic Stenosis

Nguyen

Luc

MacGillivray

et al. 2022

US Cardiology Review

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Aortic stenosis is a common form of acquired degenerative valvular disease associated with poor survival after the onset of symptoms. Treatment options for patients with aortic stenosis in addition to medical therapy include surgical aortic valve replacement (SAVR) with either tissue or mechanical valves, or transcatheter aortic valve replacement (TAVR) with either balloon-expandable or self-expanding valves via either transfemoral or alternative access routes. In this review, the authors discuss the current evidence and special considerations regarding the use of TAVR versus SAVR in the management of severe aortic stenosis in young (<65 years of age), low-risk patients, highlighting the history of aortic stenosis treatment, the current guidelines and recommendations, and important issues that remain to be addressed. Ultimately, until ongoing clinical trials with long-term follow-up data shed light on whether interventions for aortic stenosis can be broadened to a low-risk population, TAVR in young, low-risk patients should be undertaken with caution and with guidance from a multidisciplinary heart team.

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Coronary Access After Transcatheter Aortic Valve Replacement With Commissural Alignment: The ALIGN-ACCESS Study

Cited by 86 publications

References 28 publications

Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis

Comparison of cusp-overlap projection and standard three-cusp coplanar view during self-expanding transcatheter aortic valve replacement: A systematic review and meta-analysis

Commissural alignment in transcatheter aortic valve replacement: A literature review

Transcatheter Versus Surgical Aortic Valve Replacement in Young, Low-risk Patients with Severe Aortic Stenosis

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