Key result
Stepwise ACURATE neo2 valve-in-valve technique achieves patient-specific commissural alignment in a simulator and clinical case.
Why the study?
Commissural alignment is a key technical aspect of valve-in-valve TAVI for failing surgical aortic valves, where surgical alignment represents the ideal target for TAVI alignment.
Does a dedicated stepwise valve-in-valve implantation technique using ACURATE neo2 allow for patient-specific commissural alignment in degenerated surgical bioprostheses?
Does a dedicated stepwise valve-in-valve implantation technique using ACURATE neo2 allow for patient-specific commissural alignment in degenerated surgical bioprostheses?
A novel stepwise implantation technique using the ACURATE neo2 enables patient-specific commissural alignment during valve-in-valve TAVI, potentially improving coronary access.
May enable commissural alignment in valve-in-valve TAVI; hypothesis-generating and requires prospective validation before clinical adoption.
Valve-in-valve TAVI to treat failing surgical aortic valves (SAVs) is increasingly performed, and commissural alignment is a key technical aspect in such procedures. Surgeons optimize valve alignment, accounting for potential coronary eccentricity and achieving a patient-specific optimized commissural orientation, representing the ideal target for TAVI alignment. Therefore, here we present a dedicated stepwise valve-in-valve implantation technique using the ACURATE neo2. In a specific SAV postoverlap view, isolating one surgical post to the right of the screen representing the target for alignment, rotational orientation of the TAVI commissures, matching the SAV orientation, is achieved and verified before implantation. This technique has been tested in a patient-specific three-dimensionally-printed aortic root anatomy, attached to a pulsatile flow simulator, allowing for native-like simulation of coronary cannulations under fluoroscopy, and enabling detailed assessment with fluoroscopic as well as direct videographic visualization. Furthermore, the technique is exemplified by providing an educational clinical case example.
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Curio et al. (2023) studied Failing surgical aortic valves. Stepwise valve-in-valve implantation technique using the ACURATE neo2 was evaluated. A stepwise valve-in-valve implantation technique using the ACURATE neo2 achieved patient-specific commissural alignment, demonstrated in a 3D-printed simulator and a clinical case.
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