Annular-to-Apical "Emory Angle" to Ensure Coaxial Mitral Implantation of the SAPIEN 3 Valve

• Type of Material: Article
• Authors: Adam Greenbaum, Emory University; John C. Lisko, Emory Univ Hosp; Patrick Gleason, Emory University; Norihiko Kamioka, Emory University; Derek P. Metcalf, Emory University; Vasilis Babaliaros, Emory University; Kendra Grubb, Emory University; Robert Lederman, Emory University; Gaetano Paone, Emory University; Max A. Greenbaum, Independent
• Language: English
• Date: 2020-10-26
• Publisher: Elsevier Science Inc.
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2020 the American College of Cardiology Foundation. Published by Elsevier.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jcin.2020.07.024
• Title of Journal or Parent Work: JACC-Cardiovascular Interventions
• Volume: 13
• Issue: 20
• Start Page: 2447
• End Page: 2450
• Grant/Funding Information: This work was approved by the Emory University Institutional Review Board. Informed consent was not required for this retrospective analysis; Supported by Emory Structural Heart and Valve program intramural funds, and National Institutes of Health grant Z01-HL006040.
• Keywords: Cardiovascular System & Cardiology; Life Sciences & Biomedicine; Cardiac & Cardiovascular Systems; Science & Technology
• Research Categories: Health Sciences, Public Health; Health Sciences, Medicine and Surgery; Health Sciences, Health Care Management

Abstract

Paravalvular leak (PVL) remains a key limitation of transseptal transcatheter mitral valve replacement (TMVR) using the SAPIEN 3 valve (Edwards Lifesciences, Irvine, California), especially in prior surgical rings (VIR) or mitral annular calcification (VIM) (1,2). PVL often results from valve malalignment and imperfect implantation depth that allow leakage around the fabric skirt. Valve alignment is determined mainly by the position of the rigid delivery guidewire in the left ventricular (LV) apex.