The Effect of Aortic Angulation on Clinical Outcomes of Patients Undergoing Transcatheter Aortic Valve Replacement

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Severe aortic stenosis (n=264). Intervention: Aortic angulation > 48° vs. Aortic angulation ≤ 48°. Primary outcome: Cumulative events (permanent pacemaker implantation, new-onset stroke, moderate-severe paravalvular leak, and in-hospital mortality) (OR 1.73, 95% CI 0.89-3.38, p=0.104).

Q: What does this research mean for the field?

Increased aortic angulation (>48°) is not significantly associated with cumulative periprocedural and in-hospital events in patients undergoing transcatheter aortic valve replacement with new-generation self-expandable valves. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Adem Aktan; Muhammed Demir; Tuncay Güzel; Mehmet Zülküf Karahan; Burhan Aslan; Raif Kılıç; Serhat Günlü; Bayram Arslan; Mehmet Özbek; Faruk Ertaş

doi:10.21470/1678-9741-2022-0436

January 1, 2024Brazilian Journal of Cardiovascular SurgeryOpen Access

The Effect of Aortic Angulation on Clinical Outcomes of Patients Undergoing Transcatheter Aortic Valve Replacement

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Key result

Increased aortic angulation fails to increase periprocedural complications in patients undergoing TAVR.

OR 1.73
95% CI 0.89-3.38
P=0.104
n=264

Figures

Why the study?

The impact of aortic angulation on periprocedural and in-hospital complications and mortality in patients undergoing Evolut R valve implantation remained to be assessed.

Does increased aortic angulation (>48°) increase cumulative clinical events in patients undergoing transfemoral TAVR with self-expandable valves?

Study Design

Type

Observational (n=264)

Multicenter

No

Structured PICO

Does increased aortic angulation (>48°) increase cumulative clinical events in patients undergoing transfemoral TAVR with self-expandable valves?

P

Population

264 patients (mean age 78.9 years, 54.9% female) with severe aortic stenosis undergoing transfemoral transcatheter aortic valve replacement with a self-expandable valve, evaluated for in-hospital and 1-year outcomes.

E

Exposure

Transcatheter aortic valve replacement with a self-expandable valve in patients with aortic angulation > 48°

C

Comparator

Transcatheter aortic valve replacement with a self-expandable valve in patients with aortic angulation ≤ 48°

O

Outcome

Cumulative events including moderate-severe paravalvular leak, permanent pacemaker implantation, new-onset stroke, and in-hospital mortalitycomposite

Main Result

Odds Ratio: 1.73 (95% CI 0.89–3.38)

p-value: p=0.104

Increased aortic angulation does not significantly impact intraprocedural and periprocedural complications in patients undergoing TAVR with new generation self-expandable valves.

Limitations

Single center study with a limited number of patients
Retrospective nature introduces selection bias
Inclusion of only transfemoral implantation cases and new generation valves restricts generalizability
Calculation of aortic angulation was based on empirical angulation parameters
Interoperator variability was not evaluated
Single center with a limited number of patients
Retrospective nature introduces the possibility of selection bias
Inclusion of only transfemoral implantation cases and new generation valves
Calculation of AA was based on empirical angulation parameters

Implication

Aortic angulation >48° should not yet alter TAVR risk assessment; leaves open confirmation in larger prospective studies.

Abstract

INTRODUCTION: The aim of this study was to assess the impact of aortic angulation (AA) on periprocedural and in-hospital complications as well as mortality of patients undergoing Evolut™ R valve implantation. METHODS: A retrospective study was conducted on 264 patients who underwent transfemoral-approach transcatheter aortic valve replacement with self-expandable valve at our hospital between August 2015 and August 2022. These patients underwent multislice computer tomography scans to evaluate AA. Transcatheter aortic valve replacement endpoints, device success, and clinical events were assessed according to the definitions provided by the Valve Academic Research Consortium-3. Cumulative events included paravalvular leak, permanent pacemaker implantation, new-onset stroke, and in-hospital mortality. Patients were divided into two groups, AA ≤ 48° and AA > 48°, based on the mean AA measurement (48.3±8.8) on multislice computer tomography. RESULTS: Multivariable logistic regression analysis was performed to identify predictors of cumulative events, utilizing variables with a P-value < 0.2 obtained from univariable logistic regression analysis, including AA, age, hypertension, chronic renal failure, and heart failure. AA (odds ratio [OR]: 1.73, 95% confidence interval [CI]: 0.89-3.38, P=0.104), age (OR: 1.04, 95% CI: 0.99-1.10, P=0.099), hypertension (OR: 1.66, 95% CI: 0.82-3.33, P=0.155), chronic renal failure (OR: 1.82, 95% CI: 0.92-3.61, P=0.084), and heart failure (OR: 0.57, 95% CI: 0.27-1.21, P=0.145) were not found to be significantly associated with cumulative events in the multivariable logistic regression analysis. CONCLUSION: This study demonstrated that increased AA does not have a significant impact on intraprocedural and periprocedural complications of patients with new generation self-expandable valves implanted.

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Cite This Study

Aktan et al. (2024) conducted an observational in Severe aortic stenosis (n=264). Aortic angulation > 48° vs. Aortic angulation ≤ 48° was evaluated on Cumulative events (permanent pacemaker implantation, new-onset stroke, moderate-severe paravalvular leak, and in-hospital mortality) (OR 1.73, 95% CI 0.89-3.38, p=0.104). Increased aortic angulation (>48°) was not significantly associated with cumulative periprocedural and in-hospital complications (OR 1.73) compared to angulation ≤48° in patients undergoing TAVR.

synapsesocial.com/papers/6a1c3c31412da96b219cec09 https://doi.org/10.21470/1678-9741-2022-0436