Aortic Angulation and Success After Self-Expandable TAVR
What is the effect of increased aortic angulation (AA) on outcomes in transcatheter aortic valve replacement (TAVR)?
This retrospective study examined 582 patients treated with TAVR at a single site. Mean aortic angulation was 47°, and cohorts with low versus high (<48° vs. ≥48°) AA were compared with procedural findings and outcomes.
Patients were treated with balloon-expandable (n = 480) or self-expandable (n = 102) TAVR devices. In patients with balloon-expandable valves, there were no differences in procedural characteristics or outcomes. In those treated with self-expandable devices, patients with high versus low AA had lower rates of procedural success (76% vs. 96%, p = 0.002), greater need for a second valve (22% vs. 4%, p = 0.01), and greater need for post-dilation (48% vs. 14%, p < 0.001); rates of moderate or severe paravalvular regurgitation were similar (4% vs. 4%). In patients undergoing balloon-expandable valves, rates of procedural success, need for second valve, need for post-dilation, and rates of aortic valve regurgitation were not different between AA groups. There were no differences in mortality or other adverse events at 30 days, and no differences in mortality at 6 months for either valve type. On multivariable analysis, high AA was independently associated with reduced device success for self-expandable (odds ratio, 0.15; 95% confidence interval, 0.03-0.78; p = 0.02) but not balloon-expandable valves (p = 0.97).
In a single-center study, patients with increased AA have lower rates of procedural success and greater need for additional procedures when treated with self-expandable but not balloon-expandable TAVR devices.
This study raises the possibility that patients with increased AA may have lower procedural success when treated with self-expandable TAVR devices, although no differences in outcomes were observed. Importantly, this represents a single-center retrospective study at a site with greater relative experience in balloon-expandable valves, which may impact these findings. Further prospective and multicenter studies are needed to determine whether these are widespread findings.
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