Neo-Commissural Alignment by Withdrawing and Readvancing the Delivery System during Transcatheter Aortic Valve Replacement with Self-Expanding Prosthesis

Abstract

Objective: To investigate the feasibility of obtaining neo-commissural alignment by withdrawing and readvancing the delivery system during transcatheter aortic valve replacement (TAVR) with self-expanding prosthesis.

Methods: TAVR was performed in five patients with severe aortic valve stenosis by the femoral approach. The delivery catheter was withdrawn and readvanced with the opposite orientation when the Venus-A plus transcatheter heart valve (THV) centre marker was found to be overlapped with or close to the left marker at the aortic annulus level on the fluoroscopic image at the projection of the right and left coronary cusps superimposing. Neo-commissural alignment was evaluated by comparing the aortic computed tomography before TAVR with it after TAVR.

Results: The THV centre marker was overlapped with or close to the right marker at the aortic annulus level on the fluoroscopic image at the projection of the right and left coronary cusps superimposed in all the present five patients after withdrawing and readvancing the delivery system. The commissural angle deviation before vs. post TAVR was 12.3° ± 7.0°. Three of five patients had neo-commissural alignment. Two of the five patients had mild neo-commissural misalignment.

Conclusions: It is possible to obtain the neo-commissural alignment by controlling delivery catheter insertion orientation using the markers on the inflow of the Venus-A plus valve.