Increased Aortic Angulation in Transcatheter Aortic Valve Implantation– Still a Challenging Anatomy?

OBJECTIVES Increased aortic angulation (AA) is anatomically challenging during transcatheter aortic valve implantation (TAVI) and may affect procedural outcomes. This study evaluates the clinical and procedural impact of aortic angulation in contemporary TAVI procedures. METHODS This retrospective single-center observational study included 509 consecutive patients undergoing transfemoral TAVI between January 2021 and December 2024. Primary end-point was device success according to VARC-3 criteria. Secondary end-points included technical success, early safety at 30 days, procedural time, fluoroscopy time, contrast volume, paravalvular regurgitation (PVR) and permanent pacemaker implantation (PPI). Multivariable logistic and linear regression models were used to assess the association between aortic angulation (in degrees) and clinical outcomes. ROC and spline regression analyses were used to evaluate potential threshold effects. RESULTS Device success at discharge was achieved in 89.4% (455/509) of patients, technical success in 96.3% (490/509), and early safety at 30 days in 75.6% (385/509). Aortic angulation did not significantly influence device success (aOR: 0.974, 95% CI: 0.938–1.012, p = 0.175), technical success (aOR 1.034; 95% CI 0.980–1.091; P = 0.22), or early safety (aOR: 0.994, 95% CI: 0.968–1.020, p = 0.633). Similarly, no association was observed between aortic angulation and PPI (aOR 1.016; 95% CI 0.984–1.050; P = 0.34) and PVR. However, aortic angulation significantly correlated with increased fluoroscopy times (coefficient: 0.073, SE: 0.026; P = 0.006) and greater contrast usage (coefficient: 0.406, SE: 0.194; P = 0.037). CONCLUSIONS While higher aortic angulation increased procedural imaging demand, it did not adversely affect device performance or clinical safety outcomes after TAVI. Importantly, outcomes remained consistent across prosthesis types.