{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,13]],"date-time":"2026-06-13T00:04:50Z","timestamp":1781309090200,"version":"3.54.1"},"reference-count":31,"publisher":"Wiley","issue":"5","license":[{"start":{"date-parts":[[2025,1,26]],"date-time":"2025-01-26T00:00:00Z","timestamp":1737849600000},"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":[[2025,4]]},"abstract":"<jats:title>ABSTRACT<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Commissural misalignment (CMA) has demonstrated to difficult future coronary access in self\u2010expandable prosthesis and has been related with subclinical leaflet thrombosis and a potential increase in valve gradients and aortic regurgitation at follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Aims<\/jats:title><jats:p>The aim of our study was to assess the commissural alignment of the balloon expandable SAPIEN 3 valve (Edwards Lifesciences) and to evaluate its impact on transvalvular gradient and mortality at 5 years of follow\u2010up.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Consecutive patients treated with SAPIEN 3 prosthesis guided with intraprocedural transesophageal echocardiogram (TEE) with a minimal follow\u2010up of 5 years were included. Commissural alignment between the prosthesis and the native valve was measured by TEE by two independent cardiologists using a standardized 3\u2010cusp view pre and post\u2010valve deployment. CMA was defined as a neocommissure deviation &gt;\u200930\u00b0 compared with native commissures. Echocardiographic gradients and clinical events were recorded during follow\u2010up and compared between groups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>One hundred and five patients (54% male, mean age 80.4 years) were included; 63 (40%) were classified as \u201caligned\u201d (CMA\u2009&lt;\u200930\u00b0) and 42 (60%) as \u201cmisaligned\u201d (CMA\u2009&gt;\u200930\u00b0). Patients with CMA\u2009&gt;\u200930\u00b0 presented smaller aortic annulus (23.8 vs. 20.7, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.01) and received smaller valves. There was a slight increase of mean transvalvular gradient during follow\u2010up (9.2\u221210.3\u2009mmHg, <jats:italic>p<\/jats:italic>\u2009&lt;\u20090.05), without significant differences between groups. Mortality rate was 16.2% at 1 year and 49.5% at 5 years; and not related to commissural alignment.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Significant CMA is present in 40% of patients treated with SAPIEN 3 valves, however, we didn't find a significant association between CMA and gradient increase or mortality during long\u2010term follow\u2010up.<\/jats:p><\/jats:sec>","DOI":"10.1002\/ccd.31418","type":"journal-article","created":{"date-parts":[[2025,1,27]],"date-time":"2025-01-27T07:20:09Z","timestamp":1737962409000},"page":"1067-1076","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Commissural Alignment in SAPIEN 3 Valves: Impact on Gradient and Mortality at Follow\u2010Up"],"prefix":"10.1002","volume":"105","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8372-6901","authenticated-orcid":false,"given":"Leire","family":"Unzue","sequence":"first","affiliation":[{"name":"Departamento de Cardiolog\u00eda Intervencionista HM CIEC MADRID (Centro Integral de Enfermedades Cardiovasculares), HM Hospitales Madrid Spain"},{"name":"Instituto de Investigaci\u00f3n Sanitaria HM Hospitales Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bel\u00e9n D\u00edaz","family":"Ant\u00f3n","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n Sanitaria HM Hospitales Madrid Spain"},{"name":"Departamento de imagen cardiaca HM CIEC MADRID (Centro Integral de Enfermedades Cardiovasculares), HM Hospitales Madrid Spain"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adri\u00e1n Pel\u00e1ez","family":"Laderas","sequence":"additional","affiliation":[{"name":"Instituto de Investigaci\u00f3n 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