Clinical and structural outcomes of neocommissural alignment in transaxillary and transcarotid transcatheter aortic valve implantation with a self-expandable transcatheter heart valve

Victor X Mosquera; Adrian Muinelo-Paul; Oscar Pato-López; Alberto Bouzas-Mosquera; José J Cuenca-Castillo

doi:10.1016/j.xjtc.2023.06.017

Clinical and structural outcomes of neocommissural alignment in transaxillary and transcarotid transcatheter aortic valve implantation with a self-expandable transcatheter heart valve

JTCVS Tech. 2023 Jul 21:22:150-158. doi: 10.1016/j.xjtc.2023.06.017. eCollection 2023 Dec.

Authors

Victor X Mosquera^{1

2

3}, Adrian Muinelo-Paul¹, Oscar Pato-López⁴, Alberto Bouzas-Mosquera^{2

5}, José J Cuenca-Castillo^{1

2

3}

Affiliations

¹ Department of Cardiac Surgery, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
² Instituto de Investigación Biomédica de A Coruña (INIBIC), University of A Coruña, A Coruña, Spain.
³ University of Santiago de Compostela, Santiago de Compostela, Spain.
⁴ Department of Anesthesiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.
⁵ Department of Cardiology, Complejo Hospitalario Universitario de A Coruña, A Coruña, Spain.

Abstract

Objectives: This study analyzes neocommissural alignment and the clinical and hemodynamic outcomes after transaxillary and transcarotid implantation of the Acurate neo2 transcatheter heart valve.

Methods: We performed a retrospective, single-center analysis of early outcomes after transaxillary and transcarotid implantation of the Acurate neo2 transcatheter heart valve. Primary outcomes were neocommisural alignment, in-hospital mortality, and valve hemodynamic performance. Commissural alignment between native and transcatheter heart valves was assessed by transesophageal echocardiogram before and after the procedure.

Results: Between October 2021 and November 2022, 40 consecutive patients were treated with the Acurate neo2 through a transaxillary or transcarotid approach. Access was achieved via the left subclavian artery in 30 cases and the left common carotid artery in 10 cases, with a mean vessel diameter of 6.7 mm. Implants most commonly used were size M (37.5%), L (35%), and S (27.5%). On the basis of transesophageal echocardiogram analysis, there was no significant difference in mean commissural orientation between native (mean, 65.1°; SD, 41.3°) and neocommissures (mean, 64°; SD, 44.1°) (P = .661). Mean commissural orientation did not significantly differ between native and neocommissures (P = .661). Optimal alignment or mild commissural misalignment was achieved in 99.5% of cases. There were no cases of severe commissural misalignment. Postprocedural mean values for peak and mean gradients were 12.7 mm Hg and 5.2 mm Hg, respectively. There were 2 cases of moderate paravalvular leak and 4 cases of mild paravalvular leak.

Conclusions: This patient-specific technique for transaxillary and transcarotid insertion of the Acurate neo2 delivery system prevents implantations with more than mild commissural misalignment and with a high device success rate.

Keywords: computed tomography; self-expandable; transaxillary/transcarotid; transcatheter aortic valve implantation; transcatheter heart valve; transesophageal echocardiography.