Correlation Between Aortic Angulation and Outcomes of Transcatheter Aortic Valve Replacement With New-Generation Valves

Novel insights on outcome in horizontal aorta with self‐expandable new‐generation transcatheter aortic valve replacement devices

“…A similar threshold was also adjusted by previous studies. 7 Contrary to other studies, 8,10 the number of large prosthesesespecially the 34 mm device-was comparatively high (n = 107, 23.0%) and also numerously implanted in HA (n = 64, 26.6%). Similar to numerous previous studies, contrast use and radiation dose were significantly enhanced in HA as an expression for a more technically F I G U R E 3 Distribution of several adverse events in normal (above) and horizontal aorta (below) according to device size [Color figure can be viewed at wileyonlinelibrary.com] challenging procedure.…”

“…A pronounced HA with an ARA > 48° was reported to attenuate acute procedural success in self‐expandable but not balloon‐expandable TAVR 3 . However, the threshold was developed in old‐generation devices and current studies could also demonstrate that HA seems not to affect procedural success and outcome 7‐10 . On the other hand, many questions are still unacknowledged, while in clinical practice HA remains still a challenge in self‐expandable TAVR, often intensified by large annulus diameters, calcification burden, and extreme peripheral tortuosity.…”

“…3 However, the threshold was developed in old-generation devices and current studies could also demonstrate that HA seems not to affect procedural success and outcome. [7][8][9][10] On the other hand, many questions are still unacknowledged, while…”

“…Especially larger devices are often limited in controllability, although the new‐generation systems include several features to optimize device implantation in difficult and large anatomies. Among the most studies with current self‐expandable prostheses, the case numbers of very large devices are limited 8,10 and associations of AE depending on valve size and calcification burden are still lacking when arguing on horizontal anatomy.…”

“…Hitherto, HA was defined by an aortic root angulation (ARA) above 48° between the horizontal plane and the plane of the aortic annulus in coronal projection 3 . Nevertheless, the threshold was adjusted in old‐generation devices, and current studies on old and new‐generation devices yielded controversial results questioning the impact of HA on procedural success and outcome 6‐9 . Therefore, we aimed to: (a) redefine the HA threshold using new‐generation self‐expandable devices, (b) evaluate the concomitant impact on the procedural success and 30‐day outcome in a large cohort, and (c) clarify independent factors for specific AE including calcification distribution that have not been yet considered in detail.…”