Key result
Commissural and coronary alignment in TAVI facilitates coronary re-access and prevents obstruction, but durability remains unproven.
Why the study?
Commissural alignment is increasingly important in the lifetime management of younger patients with aortic stenosis undergoing TAVI, potentially influencing coronary access, valve-in-valve feasibility, and haemodynamics.
Do commissural alignment strategies during transcatheter aortic valve implantation improve coronary re-access feasibility and hemodynamics?
Do commissural alignment strategies during transcatheter aortic valve implantation improve coronary re-access feasibility and hemodynamics?
Applying specific device orientation techniques during TAVR achieves high rates of commissural alignment, which is critical for facilitating future coronary access and redo-TAVR in younger patients.
Answers are grounded in this paper and cite their sources.
May support alignment for easier coronary access and valve-in-valve in younger TAVR patients; leaves open durability effects and optimal techniques.
Commissural alignment (CA) is becoming increasingly important in the lifetime management of younger patients with aortic stenosis undergoing transcatheter aortic valve implantation, potentially influencing coronary access, valve-in-valve feasibility and haemodynamics. Interest in the topic has led to a growing body of evidence, valve design improvements and optimised implantation techniques. In this review, we summarise the clinical impact of CA, its success rate and limitations, stressing the potential role of coronary alignment as opposed to CA. We also describe the techniques to achieve CA with the latest iterations of the most used transcatheter aortic valve implantation devices.
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Fernández‐Cordón et al. (2026) conducted a review in Severe aortic stenosis. Commissural and Coronary Alignment Strategies vs. Standard/random valve implantation was evaluated. Commissural and coronary alignment techniques in transcatheter aortic valve implantation facilitate future coronary re-access and prevent coronary obstruction, though their long-term impact on valve durability remains uncertain.
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