{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,22]],"date-time":"2026-07-22T05:27:53Z","timestamp":1784698073096,"version":"3.55.0"},"reference-count":14,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2021,10,9]],"date-time":"2021-10-09T00:00:00Z","timestamp":1633737600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Cathet Cardio Intervent"],"published-print":{"date-parts":[[2022,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>We assessed the impact of conventional delivery system (DS) insertion technique on \u201cHat\u2010marker\u201d orientation\/commissural alignment in patients who underwent transcatheter aortic valve replacement (TAVR) in the Evolut Low Risk Trial CT substudy versus a modified technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Background<\/jats:title><jats:p>Unlike surgical aortic valve replacement, where alignment of the surgical valve commissures with native commissures can be achieved virtually 100% of the time, commissural alignment during TAVR is not achieved consistently. This may subsequently impact the feasibility of both coronary access and reintervention after TAVR.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>\u201cHat\u2010marker\u201d orientations during deployment were characterized as outer curve (OC), center front (CF), inner curve, and center back. Severe commissure\u2010to\u2010CA overlap was 0\u201320\u00b0. \u201cHat\u2010marker\u201d orientations and CA overlap were compared to 240 patients from a single center using the modified 3\u2010o'clock flush port DS technique.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>In the CT substudy in which conventional DS insertion was performed (flush port at 12 o'clock); 154\/249 had both analyzable CT and procedural fluoroscopy to validate \u201cHat\u2010marker\u201d to C\u2010tab\/commissural orientation. On post\u2010TAVR CT, Evolut valve commissural orientation and coronary artery (CA) ostia were identified. Compared to conventional DS technique in the CT substudy, the modified technique had higher rates of \u201cHat\u2010marker\u201d at OC\/CF orientation, improved commissural alignment and reduced severe CA overlap; (left main, 14.2 vs. 27.9%; right coronary artery, 11.7 vs. 27.3% both, 5.0 vs. 13.6%; 1 or both CA, 20.8 vs. 41.6%, all <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>The modified technique improved initial \u201cHat\u2010marker\u201d orientation during Evolut deployment and resulted in better commissural alignment and reduced CA overlap.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.29973","type":"journal-article","created":{"date-parts":[[2021,10,10]],"date-time":"2021-10-10T16:03:20Z","timestamp":1633881800000},"page":"924-931","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":10,"title":["Conventional versus modified delivery system technique in commissural alignment from the Evolut <scp>low\u2010risk CT substudy<\/scp>"],"prefix":"10.1002","volume":"99","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7219-990X","authenticated-orcid":false,"given":"Gilbert H. L.","family":"Tang","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Surgery and Cardiology Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9217-9252","authenticated-orcid":false,"given":"Aditya","family":"Sengupta","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery and Cardiology Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sophia L.","family":"Alexis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery and Cardiology Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9426-3618","authenticated-orcid":false,"given":"Syed","family":"Zaid","sequence":"additional","affiliation":[{"name":"Division of Cardiology Westchester Medical Center  Valhalla New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jonathan A.","family":"Leipsic","sequence":"additional","affiliation":[{"name":"Center for Heart Valve Innovation St. Paul's Hospital, University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Philipp","family":"Blanke","sequence":"additional","affiliation":[{"name":"Center for Heart Valve Innovation St. Paul's Hospital, University of British Columbia  Vancouver British Columbia Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kendra J.","family":"Grubb","sequence":"additional","affiliation":[{"name":"Department of Cardiothoracic Surgery Emory University  Atlanta Georgia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hemal","family":"Gada","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology University of Pittsburgh Medical Center Pinnacle  Harrisburg Pennsylvania USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0952-7509","authenticated-orcid":false,"given":"Steven J.","family":"Yakubov","sequence":"additional","affiliation":[{"name":"Department of Interventional Cardiology OhioHealth Riverside Methodist Hospital  Columbus Ohio USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Toby","family":"Rogers","sequence":"additional","affiliation":[{"name":"Medstar Heart and Vascular Institute  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stamatios","family":"Lerakis","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery and Cardiology Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sahil","family":"Khera","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery and Cardiology Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David H.","family":"Adams","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery and Cardiology Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Samin K.","family":"Sharma","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery and Cardiology Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7189-3307","authenticated-orcid":false,"given":"Annapoorna","family":"Kini","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery and Cardiology Mount Sinai Hospital  New York New York USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael J.","family":"Reardon","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Surgery Houston Methodist DeBakey Heart and Vascular Center  Houston Texas 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