Self‐expanding transcatheter aortic valve replacement in patients with extremely horizontal aortas. (30th January 2022)

• Record Type: Journal Article
• Authors: Zhou, Dao; Chen, Jun; Fan, Jiaqi; Yidilisi, Abuduwufuer; Dai, Hanyi; Xu, Yeming; Zhu, Gangjie; Guo, Yuchao; Wang, Jian'an; Liu, Xianbao
• Other Names: Gao Runlin guestEditor.; Xu Bo guestEditor.
• Is Part Of: Catheterization and cardiovascular interventions. Volume 99(2022)Supplement 1
• Page Start: 1432
• Page End: 1439
• Publication Date: 2022-01-30
• Subjects: aortic angulation -- aortic root anatomy -- device success -- extremely horizontal aorta -- transcatheter aortic valve replacement; Heart -- Diseases -- Diagnosis -- Periodicals; Cardiac catheterization -- Periodicals; 616.1207572
• DOI: 10.1002/ccd.30094
• Languages: English
• ISSNs: 1522-1946

Abstract

Abstract: Objectives: To evaluate the feasibility of self‐expanding transcatheter aortic valve replacement (TAVR) in patients with aortic stenosis and extremely horizontal aortas (aortic angulation ≥70°). Background: As TAVR using a self‐expanding prosthesis is an off‐label treatment for patients with extremely horizontal aortas, these patients are often excluded from randomized controlled trials involving self‐expanding TAVR. Methods: This study enrolled 27 consecutive patients with extremely horizontal aortas who underwent self‐expanding TAVR for severe aortic stenosis. Results: The patients' average age was 76.4 years, with a median Society of Thoracic Surgeons score of 4.53%. The device success and 30‐day mortality rates were 66.7% and 7.4%, respectively. The sinotubular junction (STJ) was significantly smaller in the device success group ( p = 0.001). The receiver operating characteristic curve analysis found that the area under the curve was 0.907 (95% confidence interval: 0.790–1.000, p = 0.001), validating the association between STJ diameter and device success. An optimal cutoff of 33.6 mm was determined using the Youden index, with a sensitivity and specificity of 88.9% and 77.8%, respectively. The device success rate was significantly higher (93.3% vs. 33.3%, p = 0.003) in patients with STJ diameters ≤33.6 mm ( n = 15). In the subgroup analyses, severe valve calcification ( n = 9) was associated with a higher incidence of moderate or severe paravalvular leakage (44.0% vs. 0%, p = 0.008), while a higher rate of second valve implantation (60.0% vs. 9.1%, p = 0.030) was found in patients with less than moderate valve calcification ( n = 5). Conclusion: Self‐expanding TAVR could be suitable for patients with extremely horizontal aortas after careful preoperative evaluation.