The Official Journal of EuroPCR and the European Association of Percutaneous Coronary Interventions (EAPCI)

Transcatheter Aortic Valve Neo-Commissure Alignment with the Portico System

DOI: 10.4244/EIJ-D-20-01095

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 [1]. 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.

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