Commissural alignment and the ACURATE neo2 transcatheter aortic valve: Impact on valve performance

• Published in: Catheterization and cardiovascular interventions Vol. 104; no. 1; pp. 115 - 124
• Main Authors: Travieso, Alejandro, Toggweiler, Stefan, Montarello, Nicholas, Renker, Matthias, Tirado‐Conte, Gabriela, Loretz, Lucca, Charitos, Efstratios I., Kim, Won‐Keun, De Backer, Ole
• Format: Journal Article
• Language: English
• Published: United States Wiley Subscription Services, Inc 01.07.2024
• Subjects: Aged; Aged, 80 and over; aortic regurgitation; Aortic stenosis; Aortic valve; Aortic Valve - diagnostic imaging; Aortic Valve - physiopathology; Aortic Valve - surgery; Aortic Valve Insufficiency - diagnostic imaging; Aortic Valve Insufficiency - etiology; Aortic Valve Insufficiency - physiopathology; Aortic Valve Stenosis - diagnostic imaging; Aortic Valve Stenosis - physiopathology; Aortic Valve Stenosis - surgery; commissural alignment; Female; Heart Valve Prosthesis; Hemodynamics; Humans; Male; Multivariate analysis; patient‐prosthesis mismatch; Prosthesis Design; Recovery of Function; Regurgitation; Retrospective Studies; Risk Factors; Severity of Illness Index; Time Factors; transcatheter aortic valve replacement; Transcatheter Aortic Valve Replacement - adverse effects; Transcatheter Aortic Valve Replacement - instrumentation; Treatment Outcome; valve performance; transcatheter aortic valve replacement; aortic regurgitation; patient‐prosthesis mismatch; commissural alignment; valve performance
• ISSN: 1522-1946; 1522-726X; 1522-726X
• DOI: 10.1002/ccd.31089

Background Transcatheter aortic valve replacement (TAVR) is increasingly being used to treat severe aortic stenosis in younger patients. Accordingly, lifetime management regarding future reintervention and coronary access is a concern. Aims To assess the impact of commissural alignment on ACURATE neo2 transcatheter aortic valve (TAV) performance. Methods COMALIGN‐neo2 was an observational, retrospective study enrolling consecutive TAVR patients treated with the ACURATE neo2 (October 2021 to October 2022). The degree of commissural (mis)‐alignment (CMA) with the native aortic valve commissures was determined and transvalvular gradient, effective orifice area, patient‐prosthesis mismatch (PPM), and aortic regurgitation (AR) were assessed. Results Among 825 patients, the mean age was 80.7 years and 42% were female. Commissural alignment was achieved in 60% of cases; mild (26%), moderate (9%), and severe misalignment (5%) were found less often. Severe PPM occurred more frequently in patients with severe CMA (14.7%) compared to aligned valves (p = 0.034). By multivariate analysis, severe CMA (odds ratio [OR]: 3.12, 95% confidence interval [CI] [1.09–8.90]; p = 0.033) and lack of postdilatation (OR: 3.85, [1.33–11.1]; p = 0.012) were associated with severe PPM. Higher rates of ≥mild AR (51.4%) were found in TAVs implanted with severe CMA compared to aligned (34.3%), mildly (38.1%) or moderately (36.0%) misaligned TAVs (p = 0.030). Multivariate analysis identified severe CMA (OR: 2.05, [1.05–4.02]; p = 0.037) to be an independent predictor of ≥mild AR. Conclusions COMALIGN‐neo2 is the largest study to date assessing the impact of commissural alignment on acute TAV performance. Severe CMA with the ACURATE neo2 platform was associated with worse valve hemodynamics and increased risk for mild AR.