In:
Catheterization and Cardiovascular Interventions, Wiley, Vol. 96, No. 7 ( 2020-12), p. 1511-1519
Abstract:
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 Contrast use (107.6 ± 50.1 vs. 94.1 ± 46.1 ml; p = .033) and radiation dose (3,176 [1,928–5,596] vs. 2,651 [1,643–4,394] Gyxcm 2 ; 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.
Type of Medium:
Online Resource
ISSN:
1522-1946
,
1522-726X
Language:
English
Publisher:
Wiley
Publication Date:
2020
detail.hit.zdb_id:
2001555-0
