Increased Aortic Angulation in Transcatheter Aortic Valve Implantation-Still a Challenging Anatomy?

Area of Science:

• Cardiology
• Interventional Cardiology
• Medical Imaging

Background:

• Increased aortic angulation (AA) presents anatomical challenges during transcatheter aortic valve implantation (TAVI).
• The impact of AA on TAVI procedural outcomes requires further evaluation.

Purpose of the Study:

• To assess the clinical and procedural implications of aortic angulation in contemporary TAVI procedures.
• To determine if AA affects device success, safety, and resource utilization.

Main Methods:

• Retrospective observational study of 509 patients undergoing transfemoral TAVI.
• Primary endpoint: device success (VARC-3 criteria). Secondary endpoints: technical success, 30-day safety, procedural time, fluoroscopy time, contrast volume, paravalvular regurgitation (PVR), and permanent pacemaker implantation (PPI).
• Statistical analysis included multivariable regression, ROC, and spline analyses to evaluate AA's association with outcomes.

Main Results:

• Device success (89.4%), technical success (96.3%), and early safety (75.6%) were achieved.
• Aortic angulation did not significantly affect device success, technical success, or early safety.
• AA correlated with increased fluoroscopy times (P=.006) and contrast usage (P=.037), but not with PVR or PPI.

Conclusions:

• Higher aortic angulation in TAVI increases procedural imaging demands (fluoroscopy and contrast).
• Aortic angulation does not adversely impact device performance or clinical safety outcomes in TAVI.
• Outcomes remained consistent across different prosthesis types, irrespective of aortic angulation.