Aortic Angulation Distribution and Effects on the Outcome and Complications of Self-expanding Transcatheter Aortic Valve Replacement

Aims To investigate the effect of aortic angulation (AA) on clinical outcomes and related complications in patients with severe aortic valve stenosis (AS) undergoing transcatheter aortic valve replacement (TAVR) with self-expanding (SE) valve. Background AA is defined as the angle between the horizontal plane on the coronal plane and the plane of the aortic valve annulus, and is an important anatomical factor in TAVR. Whether AA affects the early clinical outcomes and complications in SE-TAVR procedure is still controversial. Methods and Results This was a retrospective cohort study of 519 consecutive patients who underwent SE-TAVR in our center from January 2016 to January 2021.The range of AA in patients undergoing SE-TAVR in this study was 25°~ 93°, with an average angle of 55.4 ± 9.7°. There was a statistically significant difference in technique success between AA ≤ 55° and AA > 55° group (87.3% vs. 79.1%, P = 0.011), which was mainly due to the proportion of second-valve implantation was implanted during TAVR (8.8% vs. 19.6%, P < 0.001). Among patients with TAV, those with an AA > 55°were more likely to require second-valve implantation compared to those with an AA ≤ 55° (8.8% vs. 29.8%, P < 0.001), whereas this trend did not show significant statistical differences among patients with BAV (9.6% vs. 7.3%, P = 0.345). Conclusions Larger angulation of aortic valve has significant lower technique success of TAVR which was mainly due to increasing of second-valve implantation events in SE-TAVR patients. AA mainly affects the incidence of second-valve implantation during SE-TAVR in TAV group, rather than BAV group.