Key result
Aortic valve stenosis was associated with a larger mean aorto-ventricular angle compared to controls (47.92 vs 37.06 degrees, p<0.001), though this angle increased linearly with age in both groups.
Why the study?
Ascending thoracic aortic variation relative to the sternum is an important factor in decision-making for TAVI and minimally invasive cardiac surgery, but its prevalence in general or diseased populations has not been demonstrated.
Cross-Sectional (n=125)
Investigators blinded to identity, age, and sex
Stratified random sampling for controls
No
Absolute Event Rate: 47.92% vs 37.06%
p-value: p=<0.001
Patients presenting for aortic valve surgery, particularly those >70 years, have favorable anatomy for minimally invasive cardiac surgery through a right thoracotomy.
Larger aorto-ventricular angle in aortic stenosis may favor right thoracotomy in older patients; hypothesis-generating and requires prospective validation.
Background: There is no evidence in current literature that demonstrates the prevalence of ascending thoracic aortic variation in relation to the sternum in the general, or diseased population. This measurement has become an important factor in decision-making for Trans- Catheter Aortic Valve Implantation (TAVI) and Minimally Invasive Cardiac Surgery (MICS). Methods: We conducted a cross-sectional study in Cape Town, South Africa. We evaluated the Thoracic CT scans of pre-selected TAVI patients (n=25) and compared these to Thoracic CT scans from the same general population (n=100). Three parameters of ascending thoracic aorta variations were measured. Results: Mean aorta distance from sternum was 28.01mm (95% CI: 24.56 - 31.48) in cases and 27.34mm (95% CI: 25.49 - 29.20) in controls (p<0.001). The mean position of the aorta relative to the sternum, favoured the aorta being less than 50% of its diameter to the right, in both groups. Aorto-ventricular angle showed a mean angle (degrees) of 47.92 (95% CI: 44.36 - 51.23) in cases and 37.06 (95% CI: 35.03 - 39.09) in controls. Subgroup analysis for age >60 years revealed no difference between groups (p=0.314). An overall linear relationship of aortoventricular angle, compared to age, was demonstrated. Conclusion: Statistical analysis of ascending thoracic aorta position indicates that patients presenting for aortic valve surgery, especially older patients (>70 years), have favourable anatomy for MICS through a right thoracotomy. The aortic distance from the sternum was larger in the exposed group >60 years. Aortic valve disease does not cause variation in aorto-ventricular angle. The aorto-ventricular angle increases linearly with age, in both groups.
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Koen et al. (2021) conducted a cross-sectional in Aortic valve stenosis (n=125). Aortic valve stenosis vs. General population without aortic valve stenosis was evaluated on Aorto-ventricular angle (degrees) (p=<0.001). Aortic valve stenosis was associated with a larger mean aorto-ventricular angle compared to controls (47.92 vs 37.06 degrees, p<0.001), though this angle increased linearly with age in both groups.
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