Self‐expanding transcatheter aortic valve replacement in patients with extremely horizontal aortas

Abstract

Objectives To evaluate the feasibility of self‐expanding transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis and extremely horizontal aortas (aortic angulation ≥70°). Background As TAVR using a self‐expanding prosthesis is an off‐label treatment for patients with extremely horizontal aortas, these patients are often excluded from randomized controlled trials involving self‐expanding TAVR. Methods This study enrolled 27 consecutive patients with extremely horizontal aortas who underwent self‐expanding TAVR for severe aortic stenosis. Results The patients' average age was 76.4 years, with a median Society of Thoracic Surgeons score of 4.53%. The device success and 30‐day mortality rates were 66.7% and 7.4%, respectively. The sinotubular junction (STJ) was significantly smaller in the device success group (p = 0.001). The receiver operating characteristic curve analysis found that the area under the curve was 0.907 (95% confidence interval: 0.790–1.000, p = 0.001), validating the association between STJ diameter and device success. An optimal cutoff of 33.6 mm was determined using the Youden index, with a sensitivity and specificity of 88.9% and 77.8%, respectively. The device success rate was significantly higher (93.3% vs. 33.3%, p = 0.003) in patients with STJ diameters ≤33.6 mm (n = 15). In the subgroup analyses, severe valve calcification (n = 9) was associated with a higher incidence of moderate or severe paravalvular leakage (44.0% vs. 0%, p = 0.008), while a higher rate of second valve implantation (60.0% vs. 9.1%, p = 0.030) was found in patients with less than moderate valve calcification (n = 5). Conclusion Self‐expanding TAVR could be suitable for patients with extremely horizontal aortas after careful preoperative evaluation.