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Observational Study
. 2021 Jun 14;14(11):1209-1215.
doi: 10.1016/j.jcin.2021.03.027.

The Impact of Aortic Angulation on Contemporary Transcatheter Aortic Valve Replacement Outcomes

Giorgio A Medranda  1 , Anees Musallam  2 , Cheng Zhang  2 , Hank Rappaport  2 , Paige E Gallino  2 , Brian C Case  3 , Lowell F Satler  2 , Itsik Ben-Dor  4 , Toby Rogers  5 , Ron Waksman  6
Affiliations
Free article
Observational Study

The Impact of Aortic Angulation on Contemporary Transcatheter Aortic Valve Replacement Outcomes

Giorgio A Medranda et al. JACC Cardiovasc Interv. .
Free article

Abstract

Objectives: The aim of this study was to investigate whether the degree of aortic angulation (AA) affects outcomes after transcatheter aortic valve replacement (TAVR) using newer-generation transcatheter heart valves (THVs).

Background: AA ≥48° has been reported to adversely influence accurate THV deployment, procedural success, fluoroscopy time, and paravalvular leak (PVL) in patients undergoing TAVR with early generation self-expanding (SE) THVs.

Methods: A retrospective observational study was conducted among 841 patients across all risk strata who underwent transfemoral TAVR using the balloon-expandable (BE) SAPIEN 3 or the SE CoreValve Evolut PRO from 2015 to 2020. The previously published cutoff of 48° was used to analyze procedural success and in-hospital outcomes according to THV type. Receiver-operating characteristic analysis was performed to investigate the impact of AA on an in-hospital composite outcome (need for >1 THV, more than mild PVL, new permanent pacemaker implantation, stroke, and death).

Results: AA ≥48° did not influence outcomes in patients with BE THVs. Additionally, AA ≥48° did not influence procedural success (99.1% vs. 99.1%; p = 0.980), number of THVs used (1.02 vs. 1.04; p = 0.484), rates of more than mild PVL (0.4% vs. 0%; p = 0.486), new permanent pacemaker implantation (11.8% vs. 17.1%; p = 0.178), in-hospital stroke (3.9% vs. 1.8%; p = 0.298), or in-hospital death (0.4% vs. 0.9%; p = 0.980) in patients with SE THVs. Receiver-operating characteristic analysis demonstrated similar outcomes irrespective of AA, with areas under the curve of 0.5525 for SE THVs and 0.5115 for BE THVs.

Conclusions: AA no longer plays a role with new-generation BE or SE THVs in contemporary TAVR practice. AA ≥48° did not affect procedural success or in-hospital outcomes and should no longer be a consideration when determining THV selection.

Keywords: aortic angulation; balloon-expandable valve; self-expanding valve; transcatheter aortic valve replacement; transcatheter heart valve.

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Conflict of interest statement

Funding Support and Author Disclosures Dr. Rogers is a proctor and consultant for Medtronic and Edwards Lifesciences; is an advisory board member for Medtronic; and holds equity interest in Transmural Systems. Dr. Waksman is an advisory board member for Abbott Vascular, Amgen, Boston Scientific, Cardioset, Cardiovascular Systems, Medtronic, Philips, and Pi-Cardia; is a consultant for Abbott Vascular, Amgen, Biotronik, Boston Scientific, Cardioset, Cardiovascular Systems, Medtronic, Philips, Pi-Cardia, and Transmural Systems; has received grant support from AstraZeneca, Biotronik, Boston Scientific, and Chiesi; is a Speakers Bureau member for AstraZeneca and Chiesi; and is an investor in MedAlliance and Transmural Systems. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

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