Rationale,Definitions, Techniques,and Outcomes of Commissural Alignment in TAVR: From the ALIGN-TAVR Consortium |
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| Affiliation: | 1. Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA;2. CIRBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain;3. Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark;4. Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy;5. Department of Cardiology, Hospital Clinico Universitario de Santiago de Compostela, A Coruna, Spain;6. Division of Cardiology, A.O.U. Policlinico “G. Rodolico-San Marco,” Catania, Italy;7. Clinique Pasteur, Toulouse, France;8. Normandie Université, UNIROUEN, Rouen University Hospital, Rouen, France;9. Kerckhoff Heart Center, Bad Nauheim, Germany;10. Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA;11. Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy |
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| Abstract: | Given the expanding indications of transcatheter aortic valve replacement (TAVR) in younger patients with longer life expectancies, the ability to perform postprocedural coronary access represents a priority in their lifetime management. A growing body of evidence suggests that commissural (and perhaps coronary) alignment in TAVR impacts coronary access and valve hemodynamics as well as coronary flow and access after redo-TAVR. Recent studies have provided modified delivery system insertion and rotation techniques to obtain commissural alignment with available transcatheter heart valve devices. Moreover, patient-specific preprocedural planning and postprocedural imaging tools have been developed to facilitate and evaluate commissural alignment. Future efforts should aim to refine transcatheter heart valve and delivery system designs to make neocommissural alignment easier and more reproducible. The aim of this review is to present an in-depth insight of commissural alignment in TAVR, including its rationale, standardized definitions, technical steps, outcomes, and future directions. |
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| Keywords: | aortic stenosis commissural alignment coronary access redo-TAVR TAVR CAU" },{" #name" :" keyword" ," $" :{" id" :" kwrd0040" }," $$" :[{" #name" :" text" ," _" :" caudal CT" },{" #name" :" keyword" ," $" :{" id" :" kwrd0050" }," $$" :[{" #name" :" text" ," _" :" computed tomography LCC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0060" }," $$" :[{" #name" :" text" ," _" :" left coronary cusp NCC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0070" }," $$" :[{" #name" :" text" ," _" :" noncoronary cusp RAO" },{" #name" :" keyword" ," $" :{" id" :" kwrd0080" }," $$" :[{" #name" :" text" ," _" :" right anterior oblique RCC" },{" #name" :" keyword" ," $" :{" id" :" kwrd0090" }," $$" :[{" #name" :" text" ," _" :" right coronary cusp SAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0100" }," $$" :[{" #name" :" text" ," _" :" surgical aortic valve replacement TAVR" },{" #name" :" keyword" ," $" :{" id" :" kwrd0110" }," $$" :[{" #name" :" text" ," _" :" transcatheter aortic valve replacement THV" },{" #name" :" keyword" ," $" :{" id" :" kwrd0120" }," $$" :[{" #name" :" text" ," _" :" transcatheter heart valve |
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