Horizontal Aorta in Transcatheter Self-Expanding Valves: Insights From the HORSE International Multicentre Registry. (September 2021)

• Record Type: Journal Article
• Authors: Gallo, Francesco; Gallone, Guglielmo; Kim, Won-Keun; Reifart, Jörg; Veulemans, Verena; Zeus, Tobias; Toggweiler, Stefan; De Backer, Ole; Søndergaard, Lars; Mangieri, Antonio; Khokhar, Arif; De Marco, Federico; Regazzoli, Damiano; Reimers, Bernhard; Muntané-Carol, Guillem; Estévez-Loureiro, Rodrigo; Espino, Antonio; Moscarelli, Marco; Armario, Xavier; Mylotte, Darren; Gorla, Riccardo; Bhadra, Oliver Daniel; Conradi, Lenard; Marroquin Donday, Luis Alfonso; Nombela-Franco, Luis; Barbanti, Marco; Reddavid, Claudia; Criscione, Enrico; Brugaletta, Salvatore; Regueiro, Ander; Pérez-Fuentes, Pedro; Nicolini, Elisa; Piva, Tommaso; Tzanis, Giorgos; Rodes-Cabau, Josep; Colombo, Antonio; Giannini, Francesco;
• Is Part Of: Circulation. Volume 14:Number 9(2021)
• Publication Date: 2021-09
• Subjects: aortic valve -- bioprosthesis -- registry -- tomography -- transcatheter aortic valve replacement; Cardiovascular system -- Surgery -- Periodicals; Cardiovascular system -- Diseases -- Treatment -- Periodicals; 616.105
• DOI: 10.1161/CIRCINTERVENTIONS.121.010641
• Languages: English
• ISSNs: 1941-7640

Abstract

Abstract : Background: An increased degree of aortic angulation (AA) represents a challenging feature for bioprosthesis positioning. Whether AA has an impact on procedural outcomes of contemporary self-expanding valves remains unsettled. The aim of this study was to evaluate the impact of AA on procedural outcomes of transcatheter aortic valve replacement with contemporary self-expanding valves. Methods: The HORSE (Horizontal Aorta in Transcatheter Self-Expanding Valves) is an international, retrospective registry including 3862 consecutive patients undergoing transcatheter aortic valve replacement with either Evolut R/PRO (n=1959) or ACURATE neo (n=1903) devices. Patients undergoing Evolut R 34 mm implantation were excluded as no comparable prosthesis size for ACURATE neo is available. AA was evaluated with preprocedural computed tomography, and its impact on device success was evaluated. Results: In the overall population, AA did not have any impact upon device success, also when adjusting for in-study outcome predictors (odds ratio for 1° increment, 0.99 [95% CI, 0.98–1.01], P =0.306). However, increased AA was associated with lower device success with use of the Evolut R/PRO valves (odds ratio, 0.97 [95% CI, 0.95–0.99]; P =0.004), but not the ACURATE neo valves (odds ratio, 1.00 [95% CI, 0.98–1.03], P =0.304). The best AA cutoff value predicting device success was 49° (47% of the study cohort). Among patients with AA≥49°, Evolut R/PRO valves were associated with lower device success as compared to the ACURATE neo valve (inverse probability weighting odds ratio, 0.62 [95% CI, 0.46–0.83]; P =0.002). Conclusions: Horizontal aorta, as defined by an AA ≥49°, is a common feature among transcatheter aortic valve replacement candidates and predicts device failure of the Evolut R/PRO valves, but not of the ACURATE neo valve. AA may be an effect modifier of the association between self-expanding valve type and device success. Abstract : Supplemental Digital Content is available in the text.