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Aortic annulus angulation does not attenuate procedural success of transcatheter aortic valve replacement using a novel self-expanding bioprosthesis

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Abstract

The objectives of the study were to evaluate the impact of aortic angulation (AA) on success of transcatheter aortic valve replacement (TAVR) with a new generation self-expandable prosthesis (Medtronic Evolut R®). Specific anatomical conditions, such as for example the presence of a horizontal aorta with elevated AA, have seemed to pose a significant challenge for the correct positioning and consequent functioning of self-expandable TAVR prostheses. We assessed 146 patients treated with Evolut R. AA was measured at computed tomography and two groups were identified using as cutoff the mean AA value. Acute outcomes were collected and compared. AA mean value was 49.6 ± 9.4° (AA ≥ 50°: 76 and AA < 50°: 70 patients). Risk profile (Logistic euroSCORE: AA ≥ 50°: 15.7; 75% IQR: 11.1–22.1 vs. AA < 50°: 14.7; 75% IQR: 10.7–24.0; p = 0.8) was equivalent. Perioperative results were similar: valve resheathing (AA ≥ 50°: 21.0% vs. AA < 50°: 24.2%; p = 0.6), recapturing (AA ≥ 50°: 19.7% vs. AA < 50°: 25.7%; p = 0.3), fluoroscopy time (AA ≥ 50°: 11.1 IQR: 8.6–17.0 min. vs. AA < 50°: 11.0 IQR: 8.0–15.7 min.; p = 0.9), and contrast agent use (AA ≥ 50°: 99.0 ± 41.8 ml. vs. AA < 50°: 104.2 ± 38.5 ml.; p = 0.4). At discharge, moderate paravalvular leak was present in 8/76 (10.5%) of the AA ≥ 50° and 6/70 (8.6%) of the AA < 50° (p = 0.7) patients. Severe paravalvular leak, implantation of a second valve, and/or conversion to surgery did not occur. Early safety (AA ≥ 50°: 7.8% vs. AA < 50°: 5.7%; p = 0.6) was similar in the two groups. AA did not affect procedural outcomes and valve performance of the Evolut R prosthesis.

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Authors and Affiliations

  1. Department of Cardiology, Vivantes Klinikum Im Friedrichshain Und Am Urban, Berlin, Germany

    Giuseppe D’Ancona, Stephan Kische, Hakan Gürer & Hüseyin Ince

  2. Department of Cardiology, Vivantes Wenckebach-Klinikum, Berlin, Germany

    Mohamed El-Mawardy & Dietlind Zohlnhöfer-Momm

  3. Department of Cardiology, Vivantes Humboldt-Klinikum, Berlin, Germany

    Martin Dißmann

  4. Department of Cardiology, Vivantes Klinikum Neukölln, Berlin, Germany

    Helmut Heinze

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  1. Giuseppe D’Ancona
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  2. Stephan Kische
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  3. Mohamed El-Mawardy
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  4. Martin Dißmann
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  5. Helmut Heinze
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  6. Dietlind Zohlnhöfer-Momm
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  7. Hakan Gürer
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  8. Hüseyin Ince
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Correspondence to Giuseppe D’Ancona.

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D’Ancona, G., Kische, S., El-Mawardy, M. et al. Aortic annulus angulation does not attenuate procedural success of transcatheter aortic valve replacement using a novel self-expanding bioprosthesis. Heart Vessels 34, 1969–1975 (2019). https://doi.org/10.1007/s00380-019-01436-8

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