Effect of Aortic Angulation on Outcomes in Transcatheter Aortic Valve Implantation with the Self-Expanding Portico Valve
Serkan Aslan1
, Aysel Türkvatan2, Ahmet Güner1, Serkan Kahraman1, Ümit Bulut1, Gökhan Demirci1, Enes Arslan1, Ömer Çelik1, Mehmet Ertürk1
1Clinic of Cardiology, University of Health Sciences İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
2Clinic of Radiology, University of Health Sciences İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, İstanbul, Türkiye
Keywords: Aortic angulation; computed tomography; self-expanding valve; transcatheter aortic valve implantation
Abstract
Introduction: Aortic angulation (AA), defined as the angle between the aortic annulus plane and the horizontal plane, may result in failed prosthesis positioning. The effect of AA on the procedural and short-term outcomes with the portico valves for transcatheter aortic valve implantation (TAVI) has not been fully investigated. The present study aimed to evaluate the impact of AA on device success and early outcomes of TAVI using a selfexpanding portico valve.
Patients and Methods: Preoperative computed tomography scans of 121 consecutive patients treated with the portico valve were analyzed. TAVI device success and outcomes were determined according to VARC-3 definitions. Patients were divided into two groups based on mean AA.
Results: The mean AA was 48.7 ± 8.9°. There were no differences in technical success (92.2 vs 89.5%, p= 0.604), device success (81.2% vs 77.2%, p= 0.582), and early safety endpoints (68.8% vs 61.4%, p= 0.397) between the AA≤ 48° and AA>48° groups. The frequency and severity of paravalvular aortic regurgitation (PAR) was statistically higher in patients with AA> 48° (p= 0.028). Moreover, an increased AA was also associated with valve malposition (12.3% vs. 1.6%, p= 0.018), prolonged procedure time (85 ± 26 vs. 75 ± 20 minutes, p= 0.028), and greater Δimplantation depth (2.2 ± 0.5 vs. 0.8 ± 0.1 mm; p<0.001).
Conclusion: Despite comparable device success and early outcomes rates, increased AA is associated with higher rates of PAR and valve malposition, with the self-expanding portico valve.
Cite this article as: Aslan S, Türkvatan A, Güner A, Kahraman S, Bulut Ü, Demirci G, et al. Effect of aortic angulation on outcomes in transcatheter aortic valve implantation with the self-expanding portico valve. Koşuyolu Heart J 2022;25(2):132-140.
The approval for this study was obtained from University of Health Sciences İstanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital Ethics Committee (Decision no: 2021-73, Date: 28.09.2021).
This is retrospective study, we could not obtain written informed consent from the participants.
Externally peer-reviewed.
Concept/Design - SA, ME; Analysis/Interpretation - SA, AT, ÜB; Data Collection - SA, ÜB, GD, EA; Writing - SA, AT, AG; Critical Revision - AG, SK, ÖÇ; Final Approval - ME; Statistical Analysis - SA, SK; Overall Responsibility - SA.
The authors declared that there was no conflict of interest during the preparation and publication of this article.
The authors declared that this study has received no financial support.