Why the study?
Increased aortic angulation challenges bioprosthesis positioning, but whether it impacts procedural outcomes of contemporary self-expanding valves remains unsettled.
Does the degree of aortic angulation impact procedural device success in patients undergoing TAVR with contemporary self-expanding valves?
Observational (n=3,862)
Yes
Does the degree of aortic angulation impact procedural device success in patients undergoing TAVR with contemporary self-expanding valves?
Odds Ratio: 0.62 (95% CI 0.46–0.83)
p-value: p=0.002
A horizontal aorta (aortic angulation ≥49°) predicts lower procedural device success for Evolut R/PRO valves but not for ACURATE neo valves during TAVR.
Suggests increased aortic angulation may complicate self-expanding transcatheter valve deployment; leaves open.
Background: An increased degree of aortic angulation (AA) represents a challenging feature for bioprosthesis positioning. Whether AA has an impact on procedural outcomes of contemporary self-expanding valves remains unsettled. The aim of this study was to evaluate the impact of AA on procedural outcomes of transcatheter aortic valve replacement with contemporary self-expanding valves. Methods: The HORSE (Horizontal Aorta in Transcatheter Self-Expanding Valves) is an international, retrospective registry including 3862 consecutive patients undergoing transcatheter aortic valve replacement with either Evolut R/PRO (n=1959) or ACURATE neo (n=1903) devices. Patients undergoing Evolut R 34 mm implantation were excluded as no comparable prosthesis size for ACURATE neo is available. AA was evaluated with preprocedural computed tomography, and its impact on device success was evaluated. Results: In the overall population, AA did not have any impact upon device success, also when adjusting for in-study outcome predictors (odds ratio for 1° increment, 0.99 [95% CI, 0.98–1.01], P =0.306). However, increased AA was associated with lower device success with use of the Evolut R/PRO valves (odds ratio, 0.97 [95% CI, 0.95–0.99]; P =0.004), but not the ACURATE neo valves (odds ratio, 1.00 [95% CI, 0.98–1.03], P =0.304). The best AA cutoff value predicting device success was 49° (47% of the study cohort). Among patients with AA≥49°, Evolut R/PRO valves were associated with lower device success as compared to the ACURATE neo valve (inverse probability weighting odds ratio, 0.62 [95% CI, 0.46–0.83]; P =0.002). Conclusions: Horizontal aorta, as defined by an AA ≥49°, is a common feature among transcatheter aortic valve replacement candidates and predicts device failure of the Evolut R/PRO valves, but not of the ACURATE neo valve. AA may be an effect modifier of the association between self-expanding valve type and device success.
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Gallo et al. (2021) conducted an observational in Transcatheter aortic valve replacement (n=3,862). Evolut R/PRO valves vs. ACURATE neo valves was evaluated on Device success (OR 0.62, 95% CI 0.46-0.83, p=0.002).
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