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October 1, 2019EuroIntervention34 citations

Impact of horizontal aorta on procedural and clinical outcomes in second-generation transcatheter aortic valve implantation

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DSDaniele Di StefanoACAntonio ColomboAMAntonio Mangieri

Key Result

The presence of a horizontal aorta had no significant impact on device success compared to a normal aorta during TAVI (88.3% vs 88.0%, p=0.929).

Study Design

Type

Cohort (n=547)

Structured PICO

Does the presence of a horizontal aorta impact device success and short-term clinical outcomes in patients undergoing TAVI for symptomatic severe aortic stenosis?

P
Population
547 consecutive patients with symptomatic severe aortic stenosis undergoing transfemoral second-generation transcatheter aortic valve implantation (TAVI)
I
Intervention
Presence of horizontal aorta (aortic angulation ≥48°, n=230)
C
Comparator
Normal aorta (aortic angulation <48°, n=317)
O
Outcome
Device success and 30-day clinical outcomes according to Valve Academic Research Consortium-2 definitionscomposite

The presence of a horizontal aorta does not adversely affect device success or 30-day clinical outcomes in patients undergoing TAVI with second-generation devices, though it is associated with a higher radiation dose.

Main Result

Absolute Event Rate: 88.3% vs 88%

p-value: p=0.929

Abstract

AIMS: The aim of this study was to evaluate the impact of a horizontal aorta (HA) on device success and short-term clinical outcomes of transcatheter aortic valve implantation (TAVI). METHODS AND RESULTS: We retrospectively assessed 547 consecutive patients treated with transfemoral second-generation non-balloon-expandable (NBE) (n=447) and balloon-expandable (BE) (n=100) TAVI for symptomatic severe aortic stenosis. Aortic angulation (AA) was evaluated with preprocedural computed tomography. Patients were dichotomised according to a previously established AA cut-point: HA group (AA ≥48°, n=230) and normal aorta (NA) group (AA <48°, n=317). Endpoints were considered according to the Valve Academic Research Consortium-2 definitions. Fluoroscopy time (32.8±16.4 vs 30.3±13.9 minutes, p=0.060) and radiation dose (kerma area product 120.8±99.7 vs 103.7±81.1 Gy·cm2, p=0.033) were higher in the HA group as compared to the NA group. No difference in device success was observed between patients with and without an HA (88.3% vs 88.0%, p=0.929). No differences in device success and 30-day outcomes were observed when comparing HA and NA patients, according to BE and NBE prostheses. CONCLUSIONS: The presence of an HA has no impact on device success and short-term clinical outcomes of TAVI with either second-generation NBE or BE devices.

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Cite This Study

Stefano et al. (2019) conducted a cohort in symptomatic severe aortic stenosis (n=547). Horizontal aorta (aortic angulation ≥48°) vs. Normal aorta (aortic angulation <48°) was evaluated on Device success (p=0.929). The presence of a horizontal aorta had no significant impact on device success compared to a normal aorta during TAVI (88.3% vs 88.0%, p=0.929).

synapsesocial.com/papers/6a178c5f2540ce62a354f39fhttps://doi.org/10.4244/eij-d-19-00455
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