What question did this study set out to answer?

This study investigates how the angle of valve implantation affects its depth and the clinical outcomes for patients with aortic stenosis.

March 6, 2026Open Access

The influence of different transcatheter aortic valve implantation angles, as assessed by multidetector spiral CT scanning, on the depth of valve implantation and its impact on clinical prognosis

Q: What is the clinical evidence from this study?

Study design: Cohort. Population: High-surgical-risk adults with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=215). Intervention: Commissural alignment during TAVI vs. Commissural misalignment during TAVI. Primary outcome: Implantation depth and clinical complications at 30 days including paravalvular leakage, pacemaker implantation, valve dislocation, and quality of life by TASQ (Deep implantation rate 1.89% (Aligned) vs. 9.17% (Misaligned), p=0.020; Paravalvular leakage 6.60% vs. 19.27%, p=0.006; Pacemaker implantation 3.77% vs. 11.93%, p=0.027; Valve dislocation 5.66% vs. 15.60%, p=0.018, p=multiple significant p-values reported (<0.05)).

Key Result

Commissural alignment during TAVI was associated with shallower implantation depth at the non-coronary cusp (6.95 mm vs. 7.15 mm, p=0.035), significantly lower rates of deep implantation (1.89% vs. 9.17%, p=0.020), fewer complications including paravalvular leakage (6.60% vs.19.27%, p=0.006) and pacemaker implantation (3.77% vs. 11.93%, p=0.027), and improved 1-month quality of life scores compared to misalignment in high-risk aortic stenosis patients.

Key Points

This study investigates how the angle of valve implantation affects its depth and the clinical outcomes for patients with aortic stenosis.
Retrospective cohort analysis of 215 high-surgical-risk patients undergoing TAVI.
Patients stratified into Aligned and Misaligned groups based on commissural angle from MSCT.
Primary endpoints included implantation depth, complications, and quality of life measured by TASQ.
Misaligned group had lower implantation depths and higher rates of complications.
Notable complications in misaligned patients included increased paravalvular leakage and pacemaker implantation.
Aligned patients reported significantly better quality of life scores at 1 month.

Study Design

Type

Cohort

Multicenter

Structured PICO

Does commissural alignment during TAVI improve implantation depth, reduce complications, and improve quality of life in high-surgical-risk aortic stenosis patients?

Population

215 high-surgical-risk patients with aortic stenosis (AS) undergoing transcatheter aortic valve implantation (TAVI), mean age ~82.8, ~37% male, based in China. Key inclusion: excessively high surgical risk, unsuitable for open-heart surgery. Key exclusion: eGFR <35 mL/min, bicuspid aortic valves, valve-in-TAVI.

Intervention

Transcatheter aortic valve implantation (TAVI) with commissural alignment (0-30° commissural offset between native and bioprosthetic valve commissures)

Comparator

Transcatheter aortic valve implantation (TAVI) with commissural misalignment (>30° commissural offset)

Outcome

Implantation depth, left ventricular ejection fraction (LVEF), 30-days complications, and quality of life (Toronto Aortic Stenosis Quality of Life questionnaire [TASQ])

Achieving commissural alignment during TAVI optimizes implantation depth and significantly reduces early complications such as paravalvular leak and the need for permanent pacemakers.

Limitations

Retrospective single-center design limits causality and generalizability.
Short term follow-up limited to 1 month; long-term outcomes unknown.
Single valve platform type used, limiting applicability to other valve designs.
No standardized commissural alignment technique was used; real-world variability in operator practice.
Potential unmeasured confounders despite baseline matching.

Abstract

Purpose This study aimed to investigate the impact of commissural alignment on transcatheter aortic valve implantation (TAVI) depth and clinical outcomes using multidetector spiral computed tomography (MSCT) assessment. Methods In a retrospective cohort of 215 high-surgical-risk aortic stenosis (AS) patients undergoing TAVI (April 2020–March 2024), patients were stratified into Aligned (0–30° commissural offset, n = 106) and Misaligned (30° offset, n = 109) groups based on pre/post-procedural MSCT. Primary endpoints included implantation depth, left ventricular ejection fraction (LVEF), 30-days complications, and quality of life Toronto Aortic Stenosis Quality of Life questionnaire (TASQ). Results Misaligned patients exhibited lower implantation depths at non-coronary (7.15 ± 0.53 mm vs. 6.95 ± 0.81 mm, p = 0.035) and left coronary cusps (5.21 ± 0.64 mm vs. 4.92 ± 0.41 mm, p 0.001), with higher rates of deep implantation (10 mm: 9.17% vs. 1.89%, p = 0.020). Misalignment increased complications: paravalvular leakage (19.27% vs. 6.60%, p = 0.006), pacemaker implantation (11.93% vs. 3.77%, p = 0.027), and valve dislocation (15.60% vs. 5.66%, p = 0.018). Aligned patients reported better 1-month TASQ scores (76.65 ± 17.31 vs. 69.85 ± 16.41, p = 0.003), particularly in physical limitations ( p = 0.004) and emotional impact ( p = 0.013). Conclusion Commissural misalignment was associated with deeper valve implantation, higher complication rates, and reduced early quality of life. Precise angular alignment could optimize TAVI outcomes, potentially by improving implantation depth consistency and reducing early adverse events.

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Discussion

Authors

Shuyi Zeng

Xiangwen Liang

Journals

SHILAP Revista de lepidopterología

Frontiers in Medicine

Actions

Institutions

Yulin University

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Discussion

Cite this study

Zeng et al. (Tue,) conducted a cohort in High-surgical-risk adults with severe aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) (n=215). Commissural alignment during TAVI vs. Commissural misalignment during TAVI was evaluated on Implantation depth and clinical complications at 30 days including paravalvular leakage, pacemaker implantation, valve dislocation, and quality of life by TASQ (Deep implantation rate 1.89% (Aligned) vs. 9.17% (Misaligned), p=0.020; Paravalvular leakage 6.60% vs. 19.27%, p=0.006; Pacemaker implantation 3.77% vs. 11.93%, p=0.027; Valve dislocation 5.66% vs. 15.60%, p=0.018, p=multiple significant p-values reported (<0.05)). Commissural alignment during TAVI was associated with shallower implantation depth at the non-coronary cusp (6.95 mm vs. 7.15 mm, p=0.035), significantly lower rates of deep implantation (1.89% vs. 9.17%, p=0.020), fewer complications including paravalvular leakage (6.60% vs.19.27%, p=0.006) and pacemaker implantation (3.77% vs. 11.93%, p=0.027), and improved 1-month quality of life scores compared to misalignment in high-risk aortic stenosis patients.

www.synapsesocial.com/papers/69aa6f3c531e4c4a9ff5956f — DOI: https://doi.org/10.3389/fmed.2026.1694319

The influence of different transcatheter aortic valve implantation angles, as assessed by multidetector spiral CT scanning, on the depth of valve implantation and its impact on clinical prognosis

Key Result

Key Points

Study Design

Structured PICO

Limitations

Abstract

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Discussion

Authors

Journals

Actions

Institutions

References and Citations

Citation Network

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Discussion

Cite this study