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Transcatheter heart valve commissural alignment: an updated review

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. Ind...

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Autores principales: Akodad, Mariama, Lounes, Youcef, Meier, David, Sanguineti, Francesca, Hovasse, Thomas, Blanke, Philipp, Sathananthan, Janarthanan, Tzimas, Georgios, Leipsic, Jonathon, Wood, David A., Webb, John, Chevalier, Bernard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Frontiers Media S.A. 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10155866/
https://www.ncbi.nlm.nih.gov/pubmed/37153454
http://dx.doi.org/10.3389/fcvm.2023.1154556
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author Akodad, Mariama
Lounes, Youcef
Meier, David
Sanguineti, Francesca
Hovasse, Thomas
Blanke, Philipp
Sathananthan, Janarthanan
Tzimas, Georgios
Leipsic, Jonathon
Wood, David A.
Webb, John
Chevalier, Bernard
author_facet Akodad, Mariama
Lounes, Youcef
Meier, David
Sanguineti, Francesca
Hovasse, Thomas
Blanke, Philipp
Sathananthan, Janarthanan
Tzimas, Georgios
Leipsic, Jonathon
Wood, David A.
Webb, John
Chevalier, Bernard
author_sort Akodad, Mariama
collection PubMed
description 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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spelling pubmed-101558662023-05-04 Transcatheter heart valve commissural alignment: an updated review Akodad, Mariama Lounes, Youcef Meier, David Sanguineti, Francesca Hovasse, Thomas Blanke, Philipp Sathananthan, Janarthanan Tzimas, Georgios Leipsic, Jonathon Wood, David A. Webb, John Chevalier, Bernard Front Cardiovasc Med Cardiovascular Medicine 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. Frontiers Media S.A. 2023-04-19 /pmc/articles/PMC10155866/ /pubmed/37153454 http://dx.doi.org/10.3389/fcvm.2023.1154556 Text en © 2023 Akodad, Lounes, Meier, Sanguineti, Hovasse, Blanke, Sathananthan, Tzimas, Leipsic, Wood, Webb and Chevalier. https://creativecommons.org/licenses/by/4.0/This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY) (https://creativecommons.org/licenses/by/4.0/) . The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
spellingShingle Cardiovascular Medicine
Akodad, Mariama
Lounes, Youcef
Meier, David
Sanguineti, Francesca
Hovasse, Thomas
Blanke, Philipp
Sathananthan, Janarthanan
Tzimas, Georgios
Leipsic, Jonathon
Wood, David A.
Webb, John
Chevalier, Bernard
Transcatheter heart valve commissural alignment: an updated review
title Transcatheter heart valve commissural alignment: an updated review
title_full Transcatheter heart valve commissural alignment: an updated review
title_fullStr Transcatheter heart valve commissural alignment: an updated review
title_full_unstemmed Transcatheter heart valve commissural alignment: an updated review
title_short Transcatheter heart valve commissural alignment: an updated review
title_sort transcatheter heart valve commissural alignment: an updated review
topic Cardiovascular Medicine
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10155866/
https://www.ncbi.nlm.nih.gov/pubmed/37153454
http://dx.doi.org/10.3389/fcvm.2023.1154556
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