Transcatheter aortic valve neo-commissure alignment with the Portico system
Ana Paula Tagliari, Luca Vicentini, Jan Michael Zimmermann, Mizuki Miura, Enrico Ferrari, Daniel Perez, Philipp K. Haager, Lucas Jörg, Francesco Maisano, Maurizio Taramasso
Abstract
AIMS Aim: To provide a step-by-step recommendation on how to align the Portico transcatheter heart valve, in a reproducible and reliable way, aiming to achieve proper neo-commissure alignment during transcatheter aortic valve implantation. METHODS AND RESULTS Patient-specific 3D aortic models were developed and printed based on CT scan reconstructions, and posteriorly positioned in a transcatheter aortic valve simulator. Neo-commissures were defined as aligned if the degree of deviation, having the native commissures as reference, was between 0-15º. The proposed neo-commissure alignment concept consists in overlapping 2 native and 2 neo-commissures in the same fluoroscopic projection, by rotating clockwise the delivery system in the descending aorta. After, the delivery system is advanced through the aortic root while the new reached orientation is kept. Neo-commissures alignment concept reproducibility and consistency were evaluated in 3 different aorta models (standard, horizontal, and anteriorized), with 2 operators performing 5 deployments in each model, counting 30 deployments in total. A successful neo-commissure alignment was achieved in all deployments (100% success). CONCLUSIONS Experimental tests using 3D-printed aortic root models demonstrated the feasibility and effectiveness of Portico neo-commissures alignment. The proposed orientation steps were reproducible and reliable in all the experimental deployments performed. Further animal and human studies are required to support the proposed concept.