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Avvedimento et al. Mini-invasive Surg 2022;6:24 https://dx.doi.org/10.20517/2574-1225.2021.143 Page 7 of 11
Figure 4. Orientation-specific deployment of the Evolut THV.
Figure 5. Commissural alignment with the Evolut system. Tang et al. [20] (Permission for publication obtained).
Whenever possible, the Hat marker of the Evolut valve should be oriented in the descending aorta before
tracking across the aortic arch and valve deployment. Indeed, the position of neo-commissures can be
predicted by Hat mark orientation resulting in an anterior 90° angle position of the C-tab with respect to
both coronary ostia during valve deployment. This position of valve neo-commissures may allow easier
[23]
coronary re-access . Furthermore, in cases where the center angle projection is difficult to obtain, a lateral
approach has been described, using a CT projection where two coronaries were visible in the same plane
and its orthogonal plane . An illustration of how the radiopaque THV commissural markers should be
[24]
