Commissural Alignment With ACURATE neo2 Valve in an Unselected Population.
TAVR
commissural alignment
implantation technique
patient specific
Journal
JACC. Cardiovascular interventions
ISSN: 1876-7605
Titre abrégé: JACC Cardiovasc Interv
Pays: United States
ID NLM: 101467004
Informations de publication
Date de publication:
27 03 2023
27 03 2023
Historique:
received:
31
08
2022
revised:
08
12
2022
accepted:
10
01
2023
medline:
31
3
2023
entrez:
29
3
2023
pubmed:
30
3
2023
Statut:
ppublish
Résumé
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. 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. 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. 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 36990556
pii: S1936-8798(23)00019-5
doi: 10.1016/j.jcin.2023.01.018
pii:
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
670-677Commentaires et corrections
Type : CommentIn
Informations de copyright
Copyright © 2023 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.
Déclaration de conflit d'intérêts
Funding Support and Author Disclosures Boston Scientific helped fund this study. Dr Meduri is chief medical officer of Anteris Technologies; has received grants/research support from Boston Scientific; and has received honoraria or consultation fees from Abbott, Alleviant, Boston Scientific, Cardiovalve, VDyne, and XDot. Dr Rück has received grants from Boston Scientific; nonfinancial support from Boston Scientific during the conduct of the study; and personal fees from Boston Scientific and from Edwards Lifesciences, outside the submitted work. Dr Linder has been a proctor for Boston Scientific, and an advisory board member for Medtronic and Chiesi. Dr Settergren has been an advisory board member/consultant/proctor for Boston Scientific, Abbott Vascular, WL Gore, Edwards Lifesciences, Anteris, Holistick Medical, Cardiomech, Smartcella, Segulah, Protembis, and AstraZeneca. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.