A patient‐specific algorithm to achieve commissural alignment with Acurate Neo: The sextant technique

Aims The aim of this proof‐of‐concept study was to investigate safety and efficacy of a CT‐scan based patient‐specific algorithm to maximize coronary clearance and secondarily to achieve anatomically correct commissural alignment with the Acurate Neo device. Method and results A total of 45 consecut...

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Bibliographic Details
Published in:Catheterization and cardiovascular interventions 2021-11, Vol.98 (6), p.E847-E854
Main Authors: De Marco, Federico, Casenghi, Matteo, Spagnolo, Pietro, Popolo Rubbio, Antonio, Brambilla, Nedy, Testa, Luca, Bedogni, Francesco
Format: Article
Language:English
Subjects:
Algorithms
commissural alignment
coronary access
Coronary artery
Coronary vessels
Original Studies
Patients
TAVR
TAV‐in‐TAV
Valvular and Structural Heart Diseases
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Summary:Aims The aim of this proof‐of‐concept study was to investigate safety and efficacy of a CT‐scan based patient‐specific algorithm to maximize coronary clearance and secondarily to achieve anatomically correct commissural alignment with the Acurate Neo device. Method and results A total of 45 consecutive patients undergoing TAVR with the Acurate Neo THV were prospectively enrolled in the study. Mean age was 81.6 ± 5.5 years, mean STS score was 6.1 ± 3.7. Device success rate was 100%. Aim of the technique was to rotationally deploy the TAVR device with a commissure lying on the bisector between the coronary ostia as calculated on the pre‐procedural CT‐scan. At post‐TAVR CT‐scan, coronary clearance was achieved in 98% of patients with no cases of severe coronary artery overlap. In 42 out of 45 patients, THV was aligned or, at most, mildly misaligned; there were 2 cases of moderate misalignment without any case of severe misalignment. Post‐TAVR selective coronary artery engagement was attempted and succeeded in all patients (100%). Conclusion Our CT‐scan based patient‐specific algorithm is safe and proven to be effective in avoiding coronary artery overlap and providing commissural alignment with Acurate Neo in all treated patients.
ISSN:1522-1946
1522-726X
DOI:10.1002/ccd.29737