Observational studyInterdisciplinary cardiovascular and thoracic surgery2025
Increased Aortic Angulation in Transcatheter Aortic Valve Implantation-Still a Challenging Anatomy?
Observational study in Interdisciplinary cardiovascular and thoracic surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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8 authors.
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Abstract
objectivesIncreased 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.
methodsThis 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.
resultsDevice 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).
conclusionsWhile 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.
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