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Aim To provide a step-by-step recommendation on how to align the Portico transcatheter heart valve, in a reproducible and reliable way, aiming to achieve proper neo-commissure alignment during transcatheter aortic valve implantation. Patient-specific 3D aortic models were developed and printed based on CT scan reconstructions, and posteriorly positioned in a transcatheter aortic valve simulator. Neo-commissures were defined as aligned if the degree of deviation, having the native commissures as reference, was between 0-15º. The propose