Key result
Anatomy-tailored TAVR alignment linked to ~16-point reduction in moderate to severe commissural misalignment.
Why the study?
Tailoring the "Hat" marker position according to native valve anatomy may further optimize commissural alignment in supra-annular self-expanding transcatheter aortic valve replacement.
Does an anatomy-tailored alignment method improve commissural and coronary alignment compared to the conventional method in patients undergoing TAVR with a supra-annular self-expanding valve?
Cohort (n=172)
Does an anatomy-tailored alignment method improve commissural and coronary alignment compared to the conventional method in patients undergoing TAVR with a supra-annular self-expanding valve?
Absolute Event Rate: 14.3% vs 29.9%
p-value: p=0.013
An anatomy-tailored alignment method significantly improves commissural and coronary alignment during TAVR with self-expanding valves compared to the conventional technique.
Anatomy-tailored alignment may refine TAVR positioning; leaves open clinical outcome impact and requires prospective validation.
BACKGROUND: The conventional commissural alignment for a supra-annular self-expanding valve positions the delivery catheter flush port at the 3 o'clock orientation, with confirmation of the "Hat" marker on the outer curve at the descending aorta during transcatheter aortic valve replacement. However, tailoring the "Hat" marker position according to native valve anatomy may further optimize commissural alignment. OBJECTIVES: This study evaluated the effectiveness of a novel anatomy-tailored method compared with the conventional technique. METHODS: We analyzed 172 consecutive patients who underwent transcatheter aortic valve replacement with supra-annular self-expanding valve (Evolut FX) and postprocedural contrast-enhanced computed tomography between March 2023 and February 2025. In the anatomy-tailored approach, a single additional step was incorporated into the conventional method: the "Hat" marker was repositioned to the center back in the cusp-overlap view at the descending aorta. The aim was to align the "Hat" marker to the center-front position during valve deployment. Commissural misalignment (CMA) was evaluated according to the ALIGN-TAVR (Alignment of Transcatheter Aortic-Valve Neo-Commissures) Consortium criteria. RESULTS: The mean age was 84.5 ± 5.1 years, with 54.7% (94 of 172) male patients. Of 172 patients, 67 underwent the conventional method and 105 the anatomy-tailored method. The anatomy-tailored method yielded smaller CMA angles (14.5° [IQR: 9.8-24.1] vs 20.3° [IQR: 11.0-30.6], P = 0.031) and fewer cases of moderate/severe (>30°) CMA (14.3% [15 of 105] vs 29.9% [20 of 67], P = 0.013). Coronary overlap ≤20° (either or both) was also reduced (12.4% [13 of 105] vs 28.4% [19 of 67], P = 0.009). CONCLUSIONS: The novel and easy anatomy-tailored alignment technique improved commissural alignment compared with the conventional method. Enhanced commissural alignment was associated with better coronary alignment.
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Tominaga et al. (2026) conducted a cohort in Aortic stenosis undergoing transcatheter aortic valve replacement (n=172). Anatomy-tailored commissural alignment method vs. Conventional commissural alignment technique was evaluated on Moderate/severe (>30°) commissural misalignment (p=0.013). An anatomy-tailored alignment technique during TAVR reduced the incidence of moderate to severe commissural misalignment compared to the conventional method (14.3% vs 29.9%, P=0.013).
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