Coronary Alignment by the OctaAlign Technique Using a Myval Octacor Transcatheter Heart Valve in a Bicuspid Aortic Valve: A Case Report

The indications for transcatheter aortic valve replacement (TAVR) are expanding to include patients with lower surgical risk and younger individuals.Therefore, achieving commissural/ coronary alignment during transcatheter heart valve (THV) deployment is crucial for the lifelong management of aortic stenosis.Proper coronary alignment not only facilitates future coronary access but also aids in redo-TAVR procedures and may reduce leaflet stress, thereby decreasing the rate of bioprosthesis degeneration.Various techniques have been developed to achieve coronary alignment in self-expanding valves, each with varying levels of success.However, attempts with first-generation balloon-expandable (BE) THVs have been less promising.Additionally, current coronary alignment techniques are primarily designed for tricuspid aortic valve leaflet anatomy and may not be appropriate for bicuspid aortic valves, where the coronary cusps are asymmetric and the coronary arteries are eccentric.In this report, we introduce a novel coronary alignment technique known as "OctaAlign," which utilizes a BE valve.This technique is versatile and suitable for use in both tricuspid and bicuspid valves.