Commissural Alignment After Balloon-Expandable Transcatheter Aortic Valve Replacement Is Associated With Improved Hemodynamic Outcomes

Raschpichler, Matthias; Flint, Nir; Yoon, Sung‐Han; Kaewkes, Danon; Patel, Chinar; Singh, Chetana; Patel, Vivek; Kashif, Mohammad; Borger, Michael A.; Chakravarty, Tarun; Makkar, Raj

doi:10.1016/j.jcin.2022.04.006

Cited by 15 publications

(12 citation statements)

References 19 publications

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“…Higher rates of central leaks for misaligned valves were confirmed at 3 month follow-up [ 25 ]. The CMA-related leaflet distortion shown in Bailey’s models could support this observation, though it has not been confirmed by other studies [ 26 ].…”

Section: Possible Implications Of Commissural Alignment Beyond Corona...mentioning

confidence: 59%

“…Recently, the impact of commissural alignment on valve hemodynamic and related clinical outcomes has been retrospectively analyzed in a population of 324 consecutive patients treated with balloon-expandable THVs [ 26 ]. No overt effect of misalignment on transvalvular gradients was noted at discharge.…”

Section: Possible Implications Of Commissural Alignment Beyond Corona...mentioning

confidence: 99%

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Commissural Alignment and Coronary Access after Transcatheter Aortic Valve Replacement

Quagliana

Montarello

Willemen

et al. 2023

JCM

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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.

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Section: Possible Implications Of Commissural Alignment Beyond Corona...mentioning

confidence: 59%

Section: Possible Implications Of Commissural Alignment Beyond Corona...mentioning

confidence: 99%

Commissural Alignment and Coronary Access after Transcatheter Aortic Valve Replacement

Quagliana

Montarello

Willemen

et al. 2023

JCM

View full text Add to dashboard Cite

show abstract

“…Early immobile leaflets are presumed to generate turbulent flow eddies across the prosthesis leaflets causing increased shear stress and premature deterioration of the valve, as well facilitating clot formation that may further impair leaflet mobility [ 2 , 14 ]. Increase of valve gradients immediately following SAVI have also been shown to be a predictor of BAV thrombosis, whereas following TAVI commissural misalignment was a reported predictor in some studies [ 15 , 16 ]. The impact of subclinical BAV thrombosis on postprocedural outcomes, valve durability and function, as well as the risk of mortality and stroke remains uncertain [ 6 ].…”

Section: Discussionmentioning

confidence: 99%

Bioprosthetic Aortic Valve Thrombosis and Literature Review

Radovanovic

Nordstrom

Hanna

2022

JCDD

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An 83-year-old gentleman with a history of 23-mm Hancock-II-bioprosthetic aortic valve (BAV) replacement ten-years prior presented with symptoms of dyspnea and lower extremity edema. During the preceding seven-years, he had been noted to have asymptomatic increased mean transvalvular gradients (MG; 36–50 mmHg) felt to be due to either early bioprosthetic degeneration, pannus formation, or patient–prosthesis mismatch. An echocardiogram at the time of symptom development demonstrated significant flow acceleration through the aortic valve, mild regurgitation, and severely increased MG (48 mmHg) with prolonged acceleration time (AT, 140 msec). A trial of warfarin anticoagulation resulted in dramatic improvement after only 6 weeks with laminar flow through the AV, near-total resolution of regurgitation, and a decrease in MG to 14 mmHg and AT to 114 msec. These findings strongly suggest that BAV thrombosis was the predominant mechanism responsible for the longstanding high MG. Our case highlights that BAV thrombosis should be considered in the differential of elevated gradients regardless of the age of prosthesis, and that a trial of warfarin anticoagulation may be beneficial even if elevated gradients have been present for a prolonged period. Valvular gradients are often abnormal long before a formal diagnosis; however, these may reverse quickly with anticoagulation therapy.

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“…Another bench study with the Acurate neo THV in a valve-in-valve configuration demonstrated that THV commissural misalignment was associated with a higher incidence of paravalvular leakage and impaired leaflet motion due to interaction with the leaflets of the surgical valve ( 25 ). Recently, an association between severe commissural misalignment and an early increase in gradient following an S3 THV implant have been suggested ( 26 ). Data from the RESOLVE registry among 324 patients showed that significant commissural misalignment defined as commissural offset > 30° was observed in 52.8% of patients but was not associated with significant paravalvular leakage, intravalvular leakage, increase in the mean gradient >20 mmHg, or HALT initially.…”

Section: Clinical Impact Of Commissural Misalignmentmentioning

confidence: 99%

Transcatheter heart valve commissural alignment: an updated review

Akodad

Lounes

Meier

et al. 2023

Front. Cardiovasc. Med.

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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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Commissural Alignment After Balloon-Expandable Transcatheter Aortic Valve Replacement Is Associated With Improved Hemodynamic Outcomes

Cited by 15 publications

References 19 publications

Commissural Alignment and Coronary Access after Transcatheter Aortic Valve Replacement

Commissural Alignment and Coronary Access after Transcatheter Aortic Valve Replacement

Bioprosthetic Aortic Valve Thrombosis and Literature Review

Transcatheter heart valve commissural alignment: an updated review

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