Aortic Angulation Distribution and Effects on the Outcomes of Self-Expanding Transcatheter Aortic Valve Replacement

IF 2.5 4区医学 Q2 CARDIAC & CARDIOVASCULAR SYSTEMS

Heart, Lung and Circulation Pub Date : 2026-10-01 Epub Date: 2026-08-06 DOI:10.1016/j.hlc.2026.01.022

Qianbei He, Yuanyuan Yu, Ruitao Li, Tianyuan Xiong, Fei Chen, Yanbiao Liao, Zhengang Zhao, Zhicheng Chen, Xuechen Qiao, Zhixiang Yu, Yijian Li, Yuan Feng

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Abstract

Background

Aortic angulation (AA), defined as the angle between the horizontal plane on the coronal plane and the plane of the aortic valve annulus, is an important anatomical factor in transcatheter aortic valve replacement (TAVR). Whether AA affects early clinical outcomes and complications in self-expanding (SE)-TAVR procedures is still controversial.

Method

We conducted a retrospective cohort study of 519 consecutive patients who underwent SE-TAVR at our centre from January 2016 to January 2021. Preoperative AA, technique success, and one-year postoperative survival rates were primarily analysed.

Results

The AA of patients undergoing SE-TAVR ranged from 25° to 93°, with a mean value of 55.4°±9.7°. There was a statistically significant difference in technique success between AA≤55.5° and AA>55.5° groups (84.3% vs 75.1%, p=0.009), mainly driven by the higher proportion of second-valve implantation during TAVR (8.8% vs 19.6%, p<0.001). In valve-type subgroup analysis, larger AA demonstrated good predictive value for second-valve implantation (area under the curve 0.690; 95% confidence interval 0.617–0.763). However, AA showed limited predictive efficacy for technical success in patients with bicuspid aortic valve, and it was not associated with major complications or unplanned interventions in patients with tricuspid aortic valve.

Conclusions

A larger AA is associated with a lower rate of technical success of SE-TAVR, mainly due to an increased frequency of second-valve implantation. The impact of AA is more evident in patients with tricuspid aortic valve rather than in those with bicuspid aortic valve.

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主动脉成角分布及其对经导管主动脉瓣自扩张置换术疗效的影响。

背景：主动脉角（Aortic angle， AA）定义为冠状面水平面与主动脉瓣环平面之间的夹角，是经导管主动脉瓣置换术（TAVR）中的一个重要解剖因素。AA是否影响自扩(SE)-TAVR手术的早期临床结果和并发症仍有争议。方法：我们对2016年1月至2021年1月在我们中心连续接受SE-TAVR的519例患者进行了回顾性队列研究。主要分析术前AA、手术成功率和术后1年生存率。结果：行SE-TAVR患者的AA范围为25°~ 93°，平均值为55.4°±9.7°。AA≤55.5°组与AA>55.5°组技术成功率差异有统计学意义（84.3% vs 75.1%, p=0.009），主要原因是TAVR中第二瓣植入率较高（8.8% vs 19.6%）。结论：AA越大，SE-TAVR技术成功率越低，主要原因是第二瓣植入率增加。AA的影响在三尖瓣主动脉瓣患者中比在二尖瓣主动脉瓣患者中更明显。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Heart, Lung and Circulation CARDIAC & CARDIOVASCULAR SYSTEMS-

CiteScore

4.50

自引率

3.80%

发文量

912

审稿时长

11.9 weeks

期刊介绍： Heart, Lung and Circulation publishes articles integrating clinical and research activities in the fields of basic cardiovascular science, clinical cardiology and cardiac surgery, with a focus on emerging issues in cardiovascular disease. The journal promotes multidisciplinary dialogue between cardiologists, cardiothoracic surgeons, cardio-pulmonary physicians and cardiovascular scientists.