Durability of transcatheter aortic valve replacement (TAVR) could be limited by leaflet thrombosis. A commercially available pulse duplicator system (ViVitro Inc., Victoria, BC, Canada) was used to generate physiological flow and pressure conditions of the cardiovascular circulation. Since commissural alignment in TAVR has only recently become the focus of clinical research, there is a clear gap in understanding the long-term clinical impact of commissural alignment.
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