Given the expanding indications of transcatheter aortic valve replacement (TAVR) in younger patients with longer life expectancies, the ability to perform postprocedural coronary access represents a priority in their lifetime management. A growing body of evidence suggests that commissural (and perhaps coronary) alignment in TAVR impacts coronary access and valve hemodynamics as well as coronary flow and access after redo-TAVR. Recent studies have provided modified delivery system insertion and rotation techniques to obtain commissural alignment with available transcatheter heart valve devices. Moreover, patient-specific preprocedural planning and postprocedural imaging tools have been developed to facilitate and evaluate commissural alignment. Future efforts should aim to refine transcatheter heart valve and delivery system designs to make neocommissural alignment easier and more reproducible. The aim of this review is to present an in-depth insight of commissural alignment in TAVR, including its rationale, standardized definitions, technical steps, outcomes, and future directions.

鉴于预期寿命较长的年轻患者经导管主动脉瓣置换术 (TAVR) 的适应症不断扩大，因此能够进行术后冠状动脉通路是他们一生管理的优先事项。越来越多的证据表明，TAVR 中的连合（可能还有冠状动脉）对齐会影响冠状动脉通路和瓣膜血流动力学以及重做 TAVR 后的冠状动脉流量和通路。最近的研究提供了改进的输送系统插入和旋转技术，以获得与可用的经导管心脏瓣膜装置的连合对齐。此外，已经开发了针对患者的术前计划和术后成像工具，以促进和评估连合对齐。未来的努力应该旨在改进经导管心脏瓣膜和输送系统的设计，以使新连合对准更容易和更可重复。本综述的目的是深入了解 TAVR 中的连合对齐，包括其基本原理、标准化定义、技术步骤、结果和未来方向。