Ascending Aorta Rotational Control Improves Commissural Alignment With the Navitor Vision Delivery System

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: Patients undergoing transcatheter aortic valve replacement (TAVR) (n=36). Intervention: Ascending aorta rotation strategy vs. Descending aorta rotation strategy. Primary outcome: Commissural misalignment severity after valve release (ordinal score 1-4) (p=0.0009).

Q: What does this research mean for the field?

Rotational adjustment during advancement through the ascending aorta significantly improves commissural alignment during TAVR with the Navitor Vision valve compared to a descending aorta rotation strategy. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

Norio Tada; Yun Teng; Yusuke Enta; Masaki Nakashima; Natsuko Satomi; Daishi Tazawa; Masaki Miyasaka

doi:10.1016/j.shj.2026.101097

July 22, 2026Structural HeartOpen Access

Ascending Aorta Rotational Control Improves Commissural Alignment With the Navitor Vision Delivery System

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Why the study?

The optimal rotational strategy for commissural alignment during TAVR with the Navitor Vision nonspine delivery system remains uncertain.

Does an ascending aorta rotation strategy improve commissural alignment compared with a descending aorta rotation strategy in patients undergoing TAVR with the Navitor Vision system?

Key Points

To determine whether rotational adjustment during advancement through the ascending aorta improves commissural alignment compared with descending aortic rotation when deploying the Navitor Vision valve.
Retrospectively analyzed 36 consecutive patients undergoing TAVR with the Navitor Vision valve using either ascending aorta rotation (AAR, n = 13) or descending aorta rotation (DAR, n = 23).
Rotational adjustments were guided by computed tomography-derived cusp overlap views (NCC-isolated and LCC-isolated COVs) monitoring radiopaque marker configurations.
Commissural misalignment was graded fluoroscopically on an ordinal score of 1 to 4 (no, mild, moderate, or severe) in the NCC-isolated COV.
Commissural misalignment score immediately before deployment was significantly lower in the AAR group (median [interquartile range]: 1.0 [1.0–1.5], n = 13) than in the DAR group (3.0 [2.0–4.0], n = 15; p = 0.0004).
Misalignment severity after release remained significantly lower with AAR versus DAR (median [IQR]: 1.0 [1.0–2.0] vs. 3.0 [2.0–4.0]; p = 0.0009).
No rotation-related procedural complications occurred, and rates of permanent pacemaker implantation (7.1% vs. 9.1%; p = 0.83) and new-onset left bundle branch block (21.4% vs. 22.7%; p = 0.92) did not differ significantly.

Study Design

Type

Cohort (n=36)

Multicenter

No

Structured PICO

Does an ascending aorta rotation strategy improve commissural alignment compared with a descending aorta rotation strategy in patients undergoing TAVR with the Navitor Vision system?

P

Population

36 consecutive patients who underwent transcatheter aortic valve replacement using the Navitor Vision valve at a single center.

E

Exposure

Ascending aorta rotation (AAR) strategy (n=13): Rotational adjustment initiated at the proximal aortic arch and continuously performed during advancement through the ascending aorta under computed tomography-derived cusp overlap views.

C

Comparator

Descending aorta rotation (DAR) strategy (n=23): Rotational orientation established at the descending aorta and delivery system advanced without further rotational manipulation.

O

Outcome

Commissural misalignment assessed fluoroscopically in the NCC-isolated cusp overlap view according to radiopaque marker configuration (graded as ordinal score 1-4 for no, mild, moderate, or severe).surrogate

Main Result

Absolute Event Rate: 1% vs 3%

p-value: p=0.0009

Limitations

Single-center retrospective study with a small sample size
Commissural alignment was assessed fluoroscopically rather than by systematic post-TAVR CT
Missing data were present in the DAR group for predeployment marker assessment
Procedural safety and conduction outcomes require validation in larger studies

Implication

Performing rotational adjustment in the ascending aorta rather than the descending aorta during TAVR with the Navitor Vision nonspine delivery system significantly improves commissural alignment.

Abstract

•Ascending aortic rotation improved commissural alignment with Navitor.•Rotational timing influenced marker orientation at the annular level.•Descending aortic orientation was not consistently maintained.•Computed tomography-derived cusp overlap views guided rotational adjustment.•No rotation-related procedural complications were observed.

Discussion

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Cite This Study

Tada et al. (2026) conducted a cohort in Patients undergoing transcatheter aortic valve replacement (TAVR) (n=36). Ascending aorta rotation strategy vs. Descending aorta rotation strategy was evaluated on Commissural misalignment severity after valve release (ordinal score 1-4) (p=0.0009).

synapsesocial.com/papers/6ad0fc2515427f6a8403ff6b https://doi.org/10.1016/j.shj.2026.101097

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Ascending Aorta Rotational Control Improves Commissural Alignment With the Navitor Vision Delivery System

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

Ascending Aorta Rotational Control Improves Commissural Alignment With the Navitor Vision Delivery System

Figures

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Cite This Study

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