The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)
Transcatheter Aortic Valve Neo-Commissure Alignment with the Portico System
Ana Paula Tagliari1,2; MSc; Luca Vicentini1; Jan Michael Zimmermann3; Mizuki Miura1; Enrico Ferrari1,4; Daniel Perez1; Philipp K. Haager1,5; Lucas Jörg5; Francesco Maisano1; Maurizio Taramasso1;
1.Heart and Valve Center, University Hospital of Zurich, University of Zurich, Switzerland. 2.Postgraduate Program in Cardiology and Cardiovascular Sciences – UFRG, Brazil. 3.Mechanical and Process Engineering Department, Product Development Group Zurich, ETH Zurich, Switzerland. 4.Cardiac Surgery Department, Cardiocentro Ticino, Switzerland. 5.Kantonsspital St. Gallen, Switzerland.
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With transcatheter aortic valve implantation (TAVI) rapidly spreading its indication to lower-risk and younger patients, reliable and reproducible guidance on how to orient the transcatheter heart valve (THV) to avoid coronary overlap and improve hemodynamic performance become an urgent need. It has been recently suggested that the orientation of the neo-commissures during the navigation of the delivery system could be correlated with their final position in the aortic annulus, and consequently, modified to improve final THV orientation . However, no previous study has considered the effect of different aorta angulations and how to add this variable to a neo-commissure alignment model; and none reported the feasibility of neo-commissure alignment with the Portico system (Abbott Structural Heart, St. Paul, MN, USA). Therefore, this article aims to provide a step-by-step recommendation on how to align the Portico THV, in a reproducible and standardized way, and to present the initial results obtained in patient-specific 3D printed aortic models.