Key result
Horizontal aorta linked to ~8-fold higher 30-day mortality in self-expanding TAVR.
Why the study?
The impact of a horizontal aorta on adverse events following TAVR with new-generation self-expandable devices remains controversial and requires reevaluation of an appropriate aortic root angulation threshold.
Does a horizontal aorta (aortic root angulation ≥ 51°) increase adverse events and mortality in patients undergoing transfemoral TAVR with self-expandable new-generation devices?
Cohort (n=466)
Does a horizontal aorta (aortic root angulation ≥ 51°) increase adverse events and mortality in patients undergoing transfemoral TAVR with self-expandable new-generation devices?
A horizontal aorta (aortic root angulation ≥ 51°) is associated with increased 30-day mortality, stroke, and major vascular complications in patients undergoing TAVR with new-generation self-expandable devices.
Answers are grounded in this paper and cite their sources.
HA ≥51° was associated with higher stroke and 30-day mortality after self-expanding TAVR; leaves open whether specific devices or techniques mitigate risk.
BACKGROUND: The impact of a horizontal aorta (HA) on adverse events (AE) following in transcatheter aortic valve replacement (TAVR) is dealt controversially. Using new-generation self-expandable devices, we aimed to reevaluate an appropriate threshold of the aortic root angulation (ARA) in terms of HA and its impact on outcome. METHODS: The 466 consecutive patients, who underwent transfemoral TAVR with self-expandable new-generation devices, were analyzed. Patients were classified into cases with HA (ARA ≥ 51°; n = 225; 48%) and without HA (ARA <51°; n = 241; 52%). Primary endpoints were device success and 30-day mortality. Secondary endpoints were specific AE according to VARC-2 definitions. RESULTS: ; p = .016) were higher in HA. Primary device success was comparable (97.1 vs. 97.8%; p = .773). A 30-day mortality (3.3 vs. 0.4%; p = .038, plogrank = 0.025), stroke (7.1 vs. 2.7%; p = .033), and major vascular complications (MVASC) (6.6 vs. 2.7%; p = .050) were more frequent in HA. Pronounced calcification of the noncoronary cusp and left ventricular outflow tract, the condition of HA, as well as repositioning maneuvers were independent predictors for overall specific AE. CONCLUSION: An HA above 51° is associated with an increased rate of stroke, MVASC, and 30-day mortality. Valve size and asymmetric calcification affect the incidence of repositioning maneuvers and subsequent VARC-2 AE, indicating that an HA-together with specific anatomic features-remains a crucial factor for TAVR-related outcome with self-expandable new-generation devices.
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Veulemans et al. (2020) conducted a cohort in Aortic stenosis undergoing TAVR (n=466). Horizontal aorta (aortic root angulation ≥ 51°) vs. Without horizontal aorta (aortic root angulation < 51°) was evaluated on 30-day mortality (p=0.038). A horizontal aorta (ARA ≥ 51°) during TAVR with self-expandable devices was associated with higher 30-day mortality (3.3% vs 0.4%; p=0.038) and stroke (7.1% vs 2.7%; p=0.033).
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