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

Year: 2025

Type: article

Abstract: OBJECTIVES: Increased aortic angulation (AA) is anatomically challenging during transcatheter aortic valve implantation (TAVI) and may affect procedural outcomes. This study evaluates the clinical and procedural impact of AA in contemporary TAVI procedures. METHODS: This retrospective single-centre observational study included 509 consecutive patients undergoing transfemoral TAVI between January 2021 and December 2024. The primary end-point was device success according to VARC-3 criteria. Secondary endpoints included technical success, early safety at 30 days, procedural time, fluoroscopy time, contrast volume, paravalvular regurgitation (PVR), and permanent pacemaker implantation (PPI). Multivariable logistic and linear regression models were used to assess the association between AA (in degrees) and clinical outcomes. Receiver operating characteristic (ROC) and spline regression analyses were used to evaluate potential threshold effects. RESULTS: Device success at discharge was achieved in 89.4% (455/509) of patients, technical success in 96.3% (490/509), and early safety at 30 days in 75.6% (385/509). Aortic angulation did not significantly influence device success (adjusted odds ratio [aOR]: 0.974, 95% CI: 0.938-1.012, P = .175), technical success (aOR 1.034; 95% CI 0.980-1.091; P = .22), or early safety (aOR: 0.994, 95% CI: 0.968-1.020, P = .633). Similarly, no association was observed between AA and PPI (aOR 1.016; 95% CI 0.984-1.050; P = .34) and PVR. However, AA significantly correlated with increased fluoroscopy times (coefficient: 0.073, SE: 0.026; P = .006) and greater contrast usage (coefficient: 0.406, SE: 0.194; P = .037). CONCLUSIONS: While higher AA increased procedural imaging demand, it did not adversely affect device performance or clinical safety outcomes after TAVI. Importantly, outcomes remained consistent across prosthesis types.

Source: Interdisciplinary CardioVascular and Thoracic Surgery

DOI: 10.1093/icvts/ivaf281