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Year 2022, Volume: 25 Issue: 2, 132 - 140, 20.08.2022

Abstract

References

  • 1. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011;364:2187-98. [Crossref]
  • 2. Thourani VH, Kodali S, Makkar RR, Herrmann HC, Williams M, Babaliaros V, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: A propensity score analysis. Lancet 2016;387:2218-25. [Crossref]
  • 3. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 2019;380:1695-705. [Crossref]
  • 4. Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O’Hair D, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med 2019;380:1706-15. [Crossref]
  • 5. Van Mieghem NM, Popma JJ, Deeb GM, Yakubov SJ, Serruys PW, Windecker S, et al. Complete 2-year results confirm bayesian analysis of the SURTAVI trial. JACC Cardiovasc Interv 2020;13:323-31. [Crossref]
  • 6. Carroll JD, Mack MJ, Vemulapalli S, Herrmann HC, Gleason TG, Hanzel G, et al. STS-ACC TVT registry of transcatheter aortic valve replacement. Ann Thorac Surg 2021;111:701-22. [Crossref]
  • 7. Abramowitz Y, Maeno Y, Chakravarty T, Kazuno Y, Takahashi N, Kawamori H, et al. Aortic angulation attenuates procedural success following self-expandable but not balloon-expandable TAVR. JACC Cardiovasc Imaging 2016;9:964-72. [Crossref]
  • 8. Veulemans V, Maier O, Bosbach G, Polzin A, Piayda K, Afzal S, et al. Novel insights on outcome in horizontal aorta with self-expandable new-generation transcatheter aortic valve replacement devices. Catheter Cardiovasc Interv 2020;96:1511-19. [Crossref]
  • 9. Bob-Manuel T, Pour-Ghaz I, Sharma A, Chinta VR, Abader P, Paulus B, et al. Correlation between aortic angulation and outcomes of transcatheter aortic valve replacement with new-generation valves. Curr Probl Cardiol 2021;46:100415. [Crossref]
  • 10. Rashid HN, McCormick LM, Talman AH, Ihdayhid AR, Nerlekar N, Amiruddin AS, et al. Effect of aorto-ventricular angulation on procedural success in transcatheter aortic valve replacements with the lotus valve system. Catheter Cardiovasc Interv 2018;91:1365-70. [Crossref]
  • 11. Medranda GA, Musallam A, Zhang C, Rappaport H, Gallino PE, Case BC, et al. The impact of aortic angulation on contemporary transcatheter aortic valve replacement outcomes. JACC Cardiovasc Interv 2021;14:1209-15. [Crossref]
  • 12. Tzikas A, Amrane H, Bedogni F, Brambilla N, Kefer J, Manoharan G, et al. Transcatheter aortic valve replacement using the Portico system: 10 things to remember. J Interv Cardiol 2016;29:523-9. [Crossref]
  • 13. Blanke P, Pibarot P, Hahn R, Weissman N, Kodali S, Thourani V, et al. Computed tomography-based oversizing degrees and incidence of paravalvular regurgitation of a new generation transcatheter heart valve. JACC Cardiovasc Interv 2017;10:810-20. [Crossref]
  • 14. Wong DT, Bertaso AG, Liew GY, Thomson VS, Cunnington MS, Richardson JD, et al. Relationship of aortic annular eccentricity and paravalvular regurgitation post transcatheter aortic valve implantation with CoreValve. J Invasive Cardiol 2013;25:190-5.
  • 15. Marwan M, Achenbach S, Ensminger SM, Pflederer T, Ropers D, Ludwig J, et al. CT predictors of post-procedural aortic regurgitation in patients referred for transcatheter aortic valve implantation: An analysis of 105 patients. Int J Cardiovasc Imaging 2013;29:1191-8. [Crossref]
  • 16. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14. [Crossref]
  • 17. Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, et al. Valve academic research consortium 3: Updated endpoint definitions for aortic valve clinical research. Eur Heart J 2021;42:1825-57. [Crossref]
  • 18. Roule V, Placente A, Sabatier R, Bignon M, Saplacan V, Ivascau C, et al. Angles between the aortic root and the left ventricle assessed by MDCT are associated with the risk of aortic regurgitation after transcatheter aortic valve replacement. Heart Vessels 2018;33:58-65. [Crossref]
  • 19. Popma JJ, Reardon MJ, Yakubov SJ, Hermiller JB Jr, Harrison JK, Gleason TG, et al. Safety and efficacy of self-expanding tavr in patients with aortoventricular angulation. JACC Cardiovasc Imaging 2016;9:973-81. [Crossref]
  • 20. Gorla R, De Marco F, Garatti A, Bianchi G, Popolo Rubbio A, Acerbi E, et al. Impact of aortic angle on transcatheter aortic valve implantation outcome with Evolut-R, Portico, and Acurate-NEO. Catheter Cardiovasc Interv 2021;97:135-45. [Crossref]
  • 21. Hahn RT, Pibarot P, Weissman NJ, Rodriguez L, Jaber WA. Assessment of paravalvular aortic regurgitation after transcatheter aortic valve replacement: Intra-core laboratory variability. J Am Soc Echocardiogr 2015;28:415-22. [Crossref]
  • 22. Maisano F, Worthley S, Rodés-Cabau J, Linke AH, Fichtlscherer S, Schäfer U, et al. Early commercial experience from transcatheter aortic valve implantation using the Portico™ bioprosthetic valve: 30-day outcomes in the multicentre PORTİCO-1 study. EuroIntervention 2018;14:886-93. [Crossref]
  • 23. Linke A, Holzhey D, Möllmann H, Manoharan G, Schäfer U, Frerker C, et al. Treatment of aortic stenosis with a self-expanding, resheathable transcatheter valve: One-year results of the international multicenter Portico transcatheter aortic valve implantation system study. Circ Cardiovasc Interv 2018;11:e005206. [Crossref]
  • 24. Möllmann H, Linke A, Holzhey DM, Walther T, Manoharan G, Schäfer U, et al. Implantation and 30-day follow-up on all 4 valve sizes within the Portico transcatheter aortic bioprosthetic family. JACC Cardiovasc Interv 2017;10:1538-47. [Crossref]
  • 25. Manoharan G, Linke A, Moellmann H, Redwood S, Frerker C, Kovac J, et al. Multicentre clinical study evaluating a novel resheathable annular functioning self-expanding transcatheter aortic valve system: Safety and performance results at 30 days with the Portico system. EuroIntervention 2016;12:768-74. [Crossref]
  • 26. Schultz CJ, Tzikas A, Moelker A, Rossi A, Nuis RJ, Geleijnse MM, et al. Correlates on MSCT of paravalvular aortic regurgitation after transcatheter aortic valve implantation using the Medtronic CoreValve prosthesis. Catheter Cardiovasc Interv 2011;78:446-55. [Crossref] 27. Fontana GP, Bedogni F, Groh M, Smith D, Chehab BM, Garrett HE Jr, et al. Safety profile of an intra-annular self-expanding transcatheter aortic valve and next-generation low-profile delivery system. JACC Cardiovasc Interv 2020;13:2467-78. [Crossref]

Effect of Aortic Angulation on Outcomes in Transcatheter Aortic Valve Implantation with the Self-Expanding Portico Valve

Year 2022, Volume: 25 Issue: 2, 132 - 140, 20.08.2022

Abstract

Introduction: Aortic angulation (AA), defined as the angle between the aortic annulus plane and the horizontal plane, may result in failed prosthesis positioning. The effect of AA on the procedural and short-term outcomes with the portico valves for transcatheter aortic valve implantation (TAVI) has not been fully investigated. The present study aimed to evaluate the impact of AA on device success and early outcomes of TAVI using a selfexpanding portico valve.

Patients and Methods: Preoperative computed tomography scans of 121 consecutive patients treated with the portico valve were analyzed. TAVI device success and outcomes were determined according to VARC-3 definitions. Patients were divided into two groups based on mean AA.

Results: The mean AA was 48.7 ± 8.9°. There were no differences in technical success (92.2 vs 89.5%, p= 0.604), device success (81.2% vs 77.2%, p= 0.582), and early safety endpoints (68.8% vs 61.4%, p= 0.397) between the AA≤ 48° and AA> 48° groups. The frequency and severity of paravalvular aortic regurgitation (PAR) was statistically higher in patients with AA> 48° (p= 0.028). Moreover, an increased AA was also associated with valve malposition (12.3% vs. 1.6%, p= 0.018), prolonged procedure time (85 ± 26 vs. 75 ± 20 minutes, p= 0.028), and greater Δimplantation depth (2.2 ± 0.5 vs. 0.8 ± 0.1 mm; p< 0.001).

Conclusion: Despite comparable device success and early outcomes rates, increased AA is associated with higher rates of PAR and valve malposition, with the self-expanding portico valve.

References

  • 1. Smith CR, Leon MB, Mack MJ, Miller DC, Moses JW, Svensson LG, et al. Transcatheter versus surgical aortic-valve replacement in high-risk patients. N Engl J Med 2011;364:2187-98. [Crossref]
  • 2. Thourani VH, Kodali S, Makkar RR, Herrmann HC, Williams M, Babaliaros V, et al. Transcatheter aortic valve replacement versus surgical valve replacement in intermediate-risk patients: A propensity score analysis. Lancet 2016;387:2218-25. [Crossref]
  • 3. Mack MJ, Leon MB, Thourani VH, Makkar R, Kodali SK, Russo M, et al. Transcatheter aortic-valve replacement with a balloon-expandable valve in low-risk patients. N Engl J Med 2019;380:1695-705. [Crossref]
  • 4. Popma JJ, Deeb GM, Yakubov SJ, Mumtaz M, Gada H, O’Hair D, et al. Transcatheter aortic-valve replacement with a self-expanding valve in low-risk patients. N Engl J Med 2019;380:1706-15. [Crossref]
  • 5. Van Mieghem NM, Popma JJ, Deeb GM, Yakubov SJ, Serruys PW, Windecker S, et al. Complete 2-year results confirm bayesian analysis of the SURTAVI trial. JACC Cardiovasc Interv 2020;13:323-31. [Crossref]
  • 6. Carroll JD, Mack MJ, Vemulapalli S, Herrmann HC, Gleason TG, Hanzel G, et al. STS-ACC TVT registry of transcatheter aortic valve replacement. Ann Thorac Surg 2021;111:701-22. [Crossref]
  • 7. Abramowitz Y, Maeno Y, Chakravarty T, Kazuno Y, Takahashi N, Kawamori H, et al. Aortic angulation attenuates procedural success following self-expandable but not balloon-expandable TAVR. JACC Cardiovasc Imaging 2016;9:964-72. [Crossref]
  • 8. Veulemans V, Maier O, Bosbach G, Polzin A, Piayda K, Afzal S, et al. Novel insights on outcome in horizontal aorta with self-expandable new-generation transcatheter aortic valve replacement devices. Catheter Cardiovasc Interv 2020;96:1511-19. [Crossref]
  • 9. Bob-Manuel T, Pour-Ghaz I, Sharma A, Chinta VR, Abader P, Paulus B, et al. Correlation between aortic angulation and outcomes of transcatheter aortic valve replacement with new-generation valves. Curr Probl Cardiol 2021;46:100415. [Crossref]
  • 10. Rashid HN, McCormick LM, Talman AH, Ihdayhid AR, Nerlekar N, Amiruddin AS, et al. Effect of aorto-ventricular angulation on procedural success in transcatheter aortic valve replacements with the lotus valve system. Catheter Cardiovasc Interv 2018;91:1365-70. [Crossref]
  • 11. Medranda GA, Musallam A, Zhang C, Rappaport H, Gallino PE, Case BC, et al. The impact of aortic angulation on contemporary transcatheter aortic valve replacement outcomes. JACC Cardiovasc Interv 2021;14:1209-15. [Crossref]
  • 12. Tzikas A, Amrane H, Bedogni F, Brambilla N, Kefer J, Manoharan G, et al. Transcatheter aortic valve replacement using the Portico system: 10 things to remember. J Interv Cardiol 2016;29:523-9. [Crossref]
  • 13. Blanke P, Pibarot P, Hahn R, Weissman N, Kodali S, Thourani V, et al. Computed tomography-based oversizing degrees and incidence of paravalvular regurgitation of a new generation transcatheter heart valve. JACC Cardiovasc Interv 2017;10:810-20. [Crossref]
  • 14. Wong DT, Bertaso AG, Liew GY, Thomson VS, Cunnington MS, Richardson JD, et al. Relationship of aortic annular eccentricity and paravalvular regurgitation post transcatheter aortic valve implantation with CoreValve. J Invasive Cardiol 2013;25:190-5.
  • 15. Marwan M, Achenbach S, Ensminger SM, Pflederer T, Ropers D, Ludwig J, et al. CT predictors of post-procedural aortic regurgitation in patients referred for transcatheter aortic valve implantation: An analysis of 105 patients. Int J Cardiovasc Imaging 2013;29:1191-8. [Crossref]
  • 16. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: An update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 2015;28:1-39.e14. [Crossref]
  • 17. Généreux P, Piazza N, Alu MC, Nazif T, Hahn RT, Pibarot P, et al. Valve academic research consortium 3: Updated endpoint definitions for aortic valve clinical research. Eur Heart J 2021;42:1825-57. [Crossref]
  • 18. Roule V, Placente A, Sabatier R, Bignon M, Saplacan V, Ivascau C, et al. Angles between the aortic root and the left ventricle assessed by MDCT are associated with the risk of aortic regurgitation after transcatheter aortic valve replacement. Heart Vessels 2018;33:58-65. [Crossref]
  • 19. Popma JJ, Reardon MJ, Yakubov SJ, Hermiller JB Jr, Harrison JK, Gleason TG, et al. Safety and efficacy of self-expanding tavr in patients with aortoventricular angulation. JACC Cardiovasc Imaging 2016;9:973-81. [Crossref]
  • 20. Gorla R, De Marco F, Garatti A, Bianchi G, Popolo Rubbio A, Acerbi E, et al. Impact of aortic angle on transcatheter aortic valve implantation outcome with Evolut-R, Portico, and Acurate-NEO. Catheter Cardiovasc Interv 2021;97:135-45. [Crossref]
  • 21. Hahn RT, Pibarot P, Weissman NJ, Rodriguez L, Jaber WA. Assessment of paravalvular aortic regurgitation after transcatheter aortic valve replacement: Intra-core laboratory variability. J Am Soc Echocardiogr 2015;28:415-22. [Crossref]
  • 22. Maisano F, Worthley S, Rodés-Cabau J, Linke AH, Fichtlscherer S, Schäfer U, et al. Early commercial experience from transcatheter aortic valve implantation using the Portico™ bioprosthetic valve: 30-day outcomes in the multicentre PORTİCO-1 study. EuroIntervention 2018;14:886-93. [Crossref]
  • 23. Linke A, Holzhey D, Möllmann H, Manoharan G, Schäfer U, Frerker C, et al. Treatment of aortic stenosis with a self-expanding, resheathable transcatheter valve: One-year results of the international multicenter Portico transcatheter aortic valve implantation system study. Circ Cardiovasc Interv 2018;11:e005206. [Crossref]
  • 24. Möllmann H, Linke A, Holzhey DM, Walther T, Manoharan G, Schäfer U, et al. Implantation and 30-day follow-up on all 4 valve sizes within the Portico transcatheter aortic bioprosthetic family. JACC Cardiovasc Interv 2017;10:1538-47. [Crossref]
  • 25. Manoharan G, Linke A, Moellmann H, Redwood S, Frerker C, Kovac J, et al. Multicentre clinical study evaluating a novel resheathable annular functioning self-expanding transcatheter aortic valve system: Safety and performance results at 30 days with the Portico system. EuroIntervention 2016;12:768-74. [Crossref]
  • 26. Schultz CJ, Tzikas A, Moelker A, Rossi A, Nuis RJ, Geleijnse MM, et al. Correlates on MSCT of paravalvular aortic regurgitation after transcatheter aortic valve implantation using the Medtronic CoreValve prosthesis. Catheter Cardiovasc Interv 2011;78:446-55. [Crossref] 27. Fontana GP, Bedogni F, Groh M, Smith D, Chehab BM, Garrett HE Jr, et al. Safety profile of an intra-annular self-expanding transcatheter aortic valve and next-generation low-profile delivery system. JACC Cardiovasc Interv 2020;13:2467-78. [Crossref]
There are 26 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Original Investigations
Authors

Serkan Aslan This is me 0000-0001-9112-5754

Aysel Türkvatan This is me 0000-0002-3150-5787

Ahmet Güner This is me 0000-0001-6517-7278

Serkan Kahraman This is me 0000-0003-2796-0987

Ümit Bulut This is me 0000-0002-7686-5356

Gökhan Demirci This is me 0000-0003-2835-7530

Enes Arslan This is me 0000-0001-7006-7110

Ömer Çelik This is me 0000-0003-4768-5417

Mehmet Ertürk This is me 0000-0002-2468-2793

Publication Date August 20, 2022
Published in Issue Year 2022 Volume: 25 Issue: 2

Cite

Vancouver Aslan S, Türkvatan A, Güner A, Kahraman S, Bulut Ü, Demirci G, Arslan E, Çelik Ö, Ertürk M. Effect of Aortic Angulation on Outcomes in Transcatheter Aortic Valve Implantation with the Self-Expanding Portico Valve. Koşuyolu Heart Journal. 2022;25(2):132-40.