Aortic Angulation Attenuates Procedural Success Following Self-Expandable But Not Balloon-Expandable TAVR

Yigal Abramowitz, Yoshio Maeno, Tarun Chakravarty, Yoshio Kazuno, Nobuyuki Takahashi, Hiroyuki Kawamori, Geeteshwar Mangat, Wen Cheng, Hasan Jilaihawi, Raj R. Makkar

Research output: Contribution to journalArticlepeer-review

62 Scopus citations

Abstract

Objectives The aim of this study was to evaluate the impact of increased aortic angulation (AA) on acute procedural success following transcatheter aortic valve replacement (TAVR). Background The degree of angulation between the aorta and the heart can make accurate positioning of the bioprosthesis during TAVR more demanding, particularly in instances of an extremely angulated or horizontal aortic root. Nonetheless, there are limited data on the impact of AA on the acute success of TAVR. Methods We assessed 582 patients who underwent TAVR at our institute and had contrast computed tomography available for AA evaluation. TAVR endpoints, device success, and adverse events were considered according to the Valve Academic Research Consortium-2 definitions. Results The mean angulation of the aorta was 47.3 ± 8.7°. Patients were therefore divided into 2 groups: AA <48° and AA ≥48°. AA in the 480 patients who underwent balloon-expandable (BE) TAVR did not influence acute procedural success or short-term clinical outcome. In contrast, increased AA among the 102 patients who underwent self-expandable (SE) TAVR was found to significantly attenuate procedural success (area under the curve: 0.73; 95% confidence interval: 0.61 to 0.85; p = 0.008). The numerical cutoff for AA with the highest sum of sensitivity and specificity for device success was ≥48° (sensitivity 85%, specificity 61%). Moreover, patients whose AA was ≥48° were also associated with an increased need for a second valve and post-dilation, had increased fluoroscopy time and increased valve embolization, and had increased post-procedural paravalvular regurgitation greater than or equal to mild following SE TAVR. Major complications at 30 days, including mortality were similar between AA groups. Six-month mortality was also similar between both AA groups. Conclusions Increased aortic root angulation adversely influences acute procedural success following SE but not BE TAVR. Because of these data, BE valves may be preferred when evaluating patients with high AA before TAVR.

Original languageEnglish
Pages (from-to)964-972
Number of pages9
JournalJACC: Cardiovascular Imaging
Volume9
Issue number8
DOIs
StatePublished - 1 Aug 2016
Externally publishedYes

Keywords

  • TAVI
  • TAVR
  • aortic stenosis
  • horizontal aorta
  • transcatheter aortic valve implantation

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

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