Access path angle in transapical aortic valve replacement: risk factor for paravalvular leakage

Area of Science:

• Cardiology
• Medical Imaging
• Surgical Innovation

Background:

• Transapical transcatheter aortic valve replacement (TA-TAVR) is a crucial procedure for severe aortic stenosis.
• Optimizing TA-TAVR outcomes requires understanding patient-specific anatomical factors.
• The angle between the left ventricular (LV) long axis and LV outflow tract (αLV-LVOT) is a potential predictor of procedural success.

Purpose of the Study:

• To analyze the αLV-LVOT using cardiac computed tomography.
• To determine the association between αLV-LVOT and paravalvular leakage (PL).
• To evaluate the correlation of αLV-LVOT with fluoroscopy time and postoperative creatine kinase-MB levels in TA-TAVR.

Main Methods:

• Retrospective analysis of 81 high-risk patients undergoing TA-TAVR.
• Measurement of αLV-LVOT during systole and diastole from cardiac CT data.
• Correlation of αLV-LVOT with PL occurrence, fluoroscopy time, and creatine kinase-MB levels.

Main Results:

• Mean αLV-LVOT was approximately 61.8 degrees during systole and 61.1 degrees during diastole.
• A significantly greater mean αLV-LVOT was observed in patients with clinically significant PL (grade ≥II).
• No significant correlation was found between αLV-LVOT and fluoroscopy time or postoperative creatine kinase-MB levels.

Conclusions:

• Increased αLV-LVOT is significantly associated with higher grades of paravalvular leakage during TA-TAVR.
• The αLV-LVOT may guide the selection of the transapical implantation path.
• αLV-LVOT measurements could inform the design of future aortic valve replacement devices.