Angular plane difference in transcatheter aortic valve replacement

Introduction Optimal positioning of a transcatheter aortic valve is essential for procedural success and long-term function in TAVR. The S-curve, derived from pre-procedural imaging, guides C-arm angulation to achieve alignment with the aortic annulus and ensure accurate valve deployment. Proper alignment minimizes complications such as paravalvular leak, coronary obstruction, and conduction disturbances. Despite its clinical relevance, the relationship between native aortic annulus plane and final implanted valve orientation remains poorly understood. Variability in anatomy, valve type, and deployment dynamics may contribute to discrepancies between intended and actual valve positioning. Aim This study aimed to quantify the plane difference between the planned plane of implantation with the actual plane of implantation, stratified by valve type. Secondary analyses examined predictors of greater misalignment and its association with post-TAVR outcomes, including paravalvular leak, implantation depth, and pacemaker implantation. Methods This retrospective single-center cohort included 36 transfemoral TAVR patients who underwent pre- and post-procedural CT for S-curve assessment of native and implanted valves. The angular difference between pre- and post-procedure valve planes were calculated for each patient. Linear and logistic regression models with stepwise selection identified anatomical, echocardiographic, and procedural predictors of plane shift, post-implantation aortic insufficiency, and pacemaker implantation. Results Among 36 TAVR patients (median age 76.2 years, 27.8% male), plane difference was demonstrated in all patients 8.23 degrees median (5.2,12.62 IQR). Medtronic Evolut valves showed lower plane shift than the Edwards Sapien valves (Estimate = − 4.37, 95% CI [–8.55 to − 0.18], p = 0.042). Plane shift predicted moderate post-TAVR aortic insufficiency (OR = 1.38, 95% CI [1.04–1.83], p = 0.026. Conclusion Plane difference between planned and actual implantation plane were demonstrated in all patients. Anatomical and procedural factors influence valve alignment, underscoring the need for optimized imaging and deployment strategies to minimize post-TAVR adverse outcomes. Clinical trial number Not applicable.