• Aortic Angulation Does Not Influence Outcomes in Contemporary Transcatheter Aortic Valve Replacement

    Background: Initial experience in transcatheter aortic valve replacement (TAVR) has demonstrated that an aortic angulation (AA) greater than 48 degrees can reduce the likelihood of procedural success in high-risk patients receiving a self-expanding (SE) transcatheter heart valve (THV). It is not clear whether AA still impacts outcomes with contemporary THVs and deployment techniques.

    Methods: This was a retrospective observational study of 841 low-, intermediate-, high-, and extreme-risk patients who underwent transfemoral TAVR at our institution using either the balloon-expandable (BE) SAPIEN 3 or the SE CoreValve Evolut PRO THV from 2015-2020. The previously published cut-off of 48 degrees was used to analyze procedural success and inpatient outcomes according to THV type. We performed a receiver operating characteristic (ROC) analysis to investigate the impact AA had on an inpatient composite (need for >1 THV, >mild paravalvular (PVL), new permanent pacemaker [PPM] implantation, ischemic stroke and death).

    Results: In patients who received a BE THV, an AA >48 degrees did not influence procedural success or inpatient outcomes. In patients who received a SE THV, an AA >48 degrees did not influence procedural success (99.1% vs. 99.1%; p=0.980), number of THVs used (1.02 vs. 1.04; p=0.484), rates of >mild PVL post-TAVR (0.4% vs. 0%; p=0.486), PPM implantation post-TAVR (11.8% vs. 17.1%; p=0.178), ischemic stroke (3.9% vs. 1.8%; p=0.298), or mortality (0.4% vs. 0.9%; p=0.980). Furthermore, the ROC analysis of our composite outcome demonstrated an area under the curve for SE THVs of 0.5115 and for BE THVs of 0.5525.

    Conclusions: AA did not impact clinical outcomes after TAVR for either contemporary BE or SE THVs across all risk groups.

    Author bio

    Cardiovascular Revascularization Medicine, Volume 28, Supplement, July 2021, Page S36

    Source:

    Read the full article on Science Direct: https://www.clinicalkey.com/#!/content/playContent/1-s2.0-S1553838921003821?returnurl=null&referrer=null

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