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Meduri CU, Rück A, Linder R, Verouhis D, Settergren M, Sorajja A, Daher D, Saleh N. Commissural Alignment With ACURATE neo2 Valve in an Unselected Population. JACC Cardiovasc Interv 2023; 16:670-677. [PMID: 36990556 DOI: 10.1016/j.jcin.2023.01.018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2022] [Revised: 12/08/2022] [Accepted: 01/10/2023] [Indexed: 03/31/2023]
Abstract
BACKGROUND Commissural alignment has become an important topic in transcatheter aortic valve replacement (TAVR) because it may improve coronary access, facilitate future valve procedures, and possibly improve valve durability. The efficacy of commissural alignment with ACURATE neo2 has not yet been shown in a large population. OBJECTIVES The authors sought to determine the feasibility and success of attempting commissural alignment in an unselected TAVR population treated with the ACURATE neo2 prosthetic heart valve. METHODS A total of 170 consecutive patients underwent TAVR with a dedicated implantation technique to align the TAVR valve to the native valve. Using right-left overlap and 3-cusp views, valve orientation was adjusted by rotation of the unexpanded valve at the level of the aortic root. Effectiveness was assessed postprocedure as the degree of misalignment determined by analyzing fluoroscopic valve orientation to corresponding cusp orientation on preprocedural computed tomography. Safety endpoints included mortality, stroke/transient ischemic attack, and additional complications through 30 days. RESULTS Of 170 patients, 167 (98.2%) could be analyzed for alignment, and all 170, for safety outcomes. Most patients (97%) had successful alignment (≤ mild misalignment), with 80% with commissural alignment, while the degrees of misalignment were 17% mild, 1.2% moderate, 1.8% severe. CONCLUSIONS In this large evaluation of a commissural alignment technique, alignment was achieved in nearly all patients without safety concerns or impact to procedure duration. Commissural alignment appears effective and safe across all patients with this novel technique.
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Affiliation(s)
| | - Andreas Rück
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden. https://twitter.com/AndreasRck2
| | - Rickard Linder
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Dinos Verouhis
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Magnus Settergren
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Amalin Sorajja
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Daniel Daher
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
| | - Nawzad Saleh
- Karolinska University Hospital, Department of Cardiology, Stockholm, Sweden
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2
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Akodad M, Lounes Y, Meier D, Sanguineti F, Hovasse T, Blanke P, Sathananthan J, Tzimas G, Leipsic J, Wood DA, Webb J, Chevalier B. Transcatheter heart valve commissural alignment: an updated review. Front Cardiovasc Med 2023; 10:1154556. [PMID: 37153454 PMCID: PMC10155866 DOI: 10.3389/fcvm.2023.1154556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Accepted: 03/28/2023] [Indexed: 05/09/2023] Open
Abstract
Transcatheter aortic valve replacement (TAVR) indications recently extended to lower surgical risk patients with longer life expectancy. Commissural alignment (CA) is one of the emerging concepts and is becoming one of the cornerstones of the TAVR procedure in a patient with increased longevity. Indeed, CA may improve transcatheter heart valve (THV) hemodynamics, future coronary access, and repeatability. The definition of CA has been recently standardized by the ALIGN-TAVR consortium using a four-tier scale based on CT analysis. Progress has been made during the index TAVR procedure to optimize CA, especially with self-expandable platforms. Indeed, specific delivery catheter orientation, THV rotation, and computed-tomography-derived views have been proposed to achieve a reasonable degree of CA. Recent data demonstrate feasibility, safety, and a significant reduction in coronary overlap using these techniques, especially with self-expandable platforms. This review provides an overview of THV CA including assessment methods, alignment techniques during the index TAVR procedure with different THV platforms, the clinical impact of commissural misalignment, and challenging situations for CA.
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Affiliation(s)
- Mariama Akodad
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Interventional Cardiology Department, Massy, France
- Correspondence: Mariama Akodad
| | - Youcef Lounes
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Vascular Surgery Department, Massy, France
| | - David Meier
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Francesca Sanguineti
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Interventional Cardiology Department, Massy, France
| | - Thomas Hovasse
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Interventional Cardiology Department, Massy, France
| | - Philipp Blanke
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Janarthanan Sathananthan
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Georgios Tzimas
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Jonathon Leipsic
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - David A. Wood
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - John Webb
- Division of Cardiology and Department of Radiology, Centresfor Heart Valve Innovation and for Cardiovascular Innovation, St Paul’s and Vancouver General Hospitals, University of British Columbia, Vancouver, BC, Canada
| | - Bernard Chevalier
- Ramsay Générale de Santé, Institut Cardiovasculaire Paris Sud, Interventional Cardiology Department, Massy, France
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Tang GHL, Amat-Santos IJ, De Backer O, Avvedimento M, Redondo A, Barbanti M, Costa G, Tchétché D, Eltchaninoff H, Kim WK, Zaid S, Tarantini G, Søndergaard L. Rationale, Definitions, Techniques, and Outcomes of Commissural Alignment in TAVR: From the ALIGN-TAVR Consortium. JACC Cardiovasc Interv 2022; 15:1497-1518. [PMID: 35926918 DOI: 10.1016/j.jcin.2022.06.001] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2022] [Revised: 06/01/2022] [Accepted: 06/01/2022] [Indexed: 10/16/2022]
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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Affiliation(s)
- Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA.
| | | | - Ole De Backer
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Marisa Avvedimento
- Department of Advanced Biomedical Sciences, University of Naples Federico II, Naples, Italy
| | - Alfredo Redondo
- CIRBERCV, Hospital Clínico Universitario de Valladolid, Valladolid, Spain; Department of Cardiology, Hospital Clinico Universitario de Santiago de Compostela, A Coruna, Spain
| | - Marco Barbanti
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | - Giuliano Costa
- Division of Cardiology, A.O.U. Policlinico "G. Rodolico-San Marco," Catania, Italy
| | | | | | | | - Syed Zaid
- Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
| | - Giuseppe Tarantini
- Department of Cardiac, Thoracic and Vascular Sciences, University of Padua Medical School, Padua, Italy
| | - Lars Søndergaard
- Department of Cardiology, The Heart Center, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark.
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Tang GHL, Zaid S. Commissural (Mis)Alignment in TAVR and Hemodynamic Impact: More Questions Raised Than Answered. JACC Cardiovasc Interv 2022; 15:1137-1139. [PMID: 35680193 DOI: 10.1016/j.jcin.2022.04.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 04/27/2022] [Indexed: 11/16/2022]
Affiliation(s)
- Gilbert H L Tang
- Department of Cardiovascular Surgery, Mount Sinai Health System, New York, New York, USA.
| | - Syed Zaid
- Department of Cardiology, Houston Methodist DeBakey Heart and Vascular Center, Houston, Texas, USA
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Aortic Sinus Contrast Retention During TAVR. JACC Case Rep 2022; 4:666-670. [PMID: 35677788 PMCID: PMC9168964 DOI: 10.1016/j.jaccas.2022.03.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 03/28/2022] [Indexed: 11/22/2022]
Abstract
Sinus contrast material retention after transcatheter aortic valve replacement (TAVR) is a rare phenomenon that may reflect an increased risk for thrombotic complications. We present 3 cases of persistent contrast agent retention in the sinus of Valsalva during the TAVR procedure that portend the occurrence of embolic stroke or bioprosthetic valve thrombosis. (Level of Difficulty: Advanced.)
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6
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Costa G, Sgroi C, Strazzieri O, Reddavid C, Valvo R, Motta S, Frittitta V, Dipietro E, Tamburino C, Barbanti M. Intentional Misalignment of a Transcatheter Aortic Valve to Preserve Reaccess to Coronaries of Anomalous Origin. JACC Case Rep 2022; 4:83-86. [PMID: 35106489 PMCID: PMC8784705 DOI: 10.1016/j.jaccas.2021.12.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Revised: 11/30/2021] [Accepted: 12/03/2021] [Indexed: 11/22/2022]
Abstract
Achieving patient-specific commissural alignment of transcatheter aortic valves is particularly important to ensure coronary reaccess after transcatheter aortic valve implantation. Nevertheless, in case of uncommon origin of coronary arteries, commissural alignment could be counterproductive. This case shows how alignment techniques could serve to intentionally misalign the neocommissures in this subset of patients. (Level of Difficulty: Intermediate.)
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Marco Barbanti
- Address for correspondence: Dr. Marco Barbanti, Division of Cardiology, A.O.U. Policlinico “G. Rodolico - San Marco,” Via Santa Sofia 78, 95123 Catania, Italy.
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7
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Vogl BJ, Darestani YM, Lilly SM, Thourani VH, Alkhouli MA, Lindman BR, Hatoum H. Impact of blood pressure on coronary perfusion and valvular hemodynamics after aortic valve replacement. Catheter Cardiovasc Interv 2021; 99:1214-1224. [PMID: 34936723 DOI: 10.1002/ccd.30052] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 11/05/2021] [Accepted: 11/27/2021] [Indexed: 11/11/2022]
Abstract
OBJECTIVE Our objective was to evaluate the impact of various blood pressures (BPs) on coronary perfusion and valvular hemodynamics following aortic valve replacement (AVR). BACKGROUND Lower systolic and diastolic (SBP/DBP) pressures from the recommended optimal target range of SBP < 120-130 mmHg and DBP < 80 mmHg after AVR have been independently associated with increased cardiovascular and all-cause mortality. METHODS The hemodynamic assessment of a 26 mm SAPIEN 3 transcatheter aortic valve (TAV), 29 mm Evolut R TAV, and 25 mm Magna Ease surgical aortic valve (SAV) was performed in a pulsed left heart simulator with varying SBP, DBP, and heart rate (HR) conditions (60 and 120 bpm) at 5 L/min cardiac output (CO). Average coronary flow (CF), effective orifice areas (EOAs), and valvulo-arterial impedance (Zva) were calculated. RESULTS At HR of 60 bpm, at SBP < 120 mmHg and DBP < 60 mmHg, CF decreased below the physiological lower limit with several different valves. Zva and EOA were found to increase and decrease respectively with increasing SBP and DBP. The same results were found with an HR of 120 bpm. The trends of CF variation with BP were similar in all valves however the drop below the lower physiological CF limit was valve dependent. CONCLUSION In a controlled in vitro system, with different aortic valve prostheses in place, CF decreased below the physiologic minimum when SBP and DBP were in the range targeted by blood pressure guidelines. Combined with recent observations from patients treated with AVR, these findings underscore the need for additional studies to identify the optimal BP in patients treated with AVR for AS.
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Affiliation(s)
- Brennan J Vogl
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA
| | - Yousef M Darestani
- Department of Civil, Environmental and Geospatial Engineering, Michigan Technological University, Houghton, Michigan, USA
| | - Scott M Lilly
- Department of Cardiovascular Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Vinod H Thourani
- Department of Cardiovascular Surgery, Marcus Valve Center, Piedmont Heart Institute, Atlanta, Georgia, USA
| | - Mohamad A Alkhouli
- Department of Cardiovascular Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Brian R Lindman
- Structural Heart and Valve Center, Division of Cardiovascular Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Hoda Hatoum
- Department of Biomedical Engineering, Michigan Technological University, Houghton, Michigan, USA.,Center of Biocomputing and Digital Health and Institute of Computing and Cybernetics, Michigan Technological University, Houghton, Michigan, USA.,Health Research Institute, Michigan Technological University, Houghton, Michigan, USA
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8
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Tagliari A, Vicentini L, Zimmermann J, Miura M, Ferrari E, Perez D, Haager P, Jörg L, Maisano F, Taramasso M. Transcatheter aortic valve neo-commissure alignment with the Portico system. EUROINTERVENTION 2021; 17:e152-e155. [PMID: 33342763 PMCID: PMC9725055 DOI: 10.4244/eij-d-20-01095] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Affiliation(s)
- Ana Tagliari
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland,Postgraduate Program in Cardiology and Cardiovascular Sciences – UFRG, Porto Alegre, Brazil
| | - Luca Vicentini
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Jan Zimmermann
- Mechanical and Process Engineering Department, Product Development Group Zurich, ETH Zurich, Zurich, Switzerland
| | - Mizuki Miura
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Enrico Ferrari
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland,Cardiac Surgery Department, Cardiocentro Ticino, Lugano, Switzerland
| | - Daniel Perez
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Philipp Haager
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland,Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Lucas Jörg
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland,Kantonsspital St. Gallen, St. Gallen, Switzerland
| | - Francesco Maisano
- Heart and Valve Center, University Hospital of Zurich, University of Zurich, Zurich, Switzerland
| | - Maurizio Taramasso
- University Hospital of Zurich, Rämistrasse 100, CH-8091 Zurich, Switzerland
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Mela P. Subject- and Leaflet-Specific Remodeling of Polymeric Heart Valves for In Situ Tissue Engineering: Challenges Towards Clinical Translation. JACC Basic Transl Sci 2020; 5:32-34. [PMID: 32043486 PMCID: PMC7000880 DOI: 10.1016/j.jacbts.2019.12.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Affiliation(s)
- Petra Mela
- Chair of Medical Materials and Implants, Department of Mechanical Engineering and Munich School of BioEngineering, Technical University of Munich, Garching, Germany
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