CT-Derived Aortic Valve Anatomy and Acute Complications After Self-Expanding and Balloon-Expandable TAVI

Background and Objectives: This study aimed to assess the clinical and anatomical predictors of acute cardiac complications after transcatheter aortic valve implantation (TAVI). Materials and Methods: All patients who underwent a TAVI procedure for severe aortic stenosis between November 2016 and May 2025 at a tertiary center in Romania were screened for inclusion. Of those, patients who had available computer tomography valvular sizing reports were included in the present study. Results: A total of 485 patients were included in this study. Balloon-expandable valves were implanted in 381 patients (78.5%), while self-expanding valves were used in 104 patients (21.4%). A total of sixty-nine (14.2%) patients suffered at least one acute cardiac complication following TAVI, and in-hospital death occurred in nine (1.8%) patients. In the multivariable analysis, clinical parameters—such as diabetes mellitus, left bundle branch block, or left ventricular diameter—and anatomic parameters, such as left coronary artery height and sinotubular junction height, were predictors of acute complications. Similarly, periprocedural characteristics, such as maximum transprosthetic gradient and the use of the Portico/Navitor valve platform was also associated with the occurrence of acute complications. Conclusions: A high acute complications rate is typical for TAVI, although most complications can be successfully treated and the in-hospital death rate is low. Left coronary artery height and sinotubular junction height were predictors of acute complications, among other clinical and procedural characteristics.