C-50 | Association of Aortoventricular Angulation and Clinical Outcomes After Self-Expanding TAVR (2022)

BackgroundFor patients undergoing transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEV), greater aortoventricular (AoV) angulation has been identified as a technical challenge. However, it remains unclear if AoV angle affects early clinical outcomes. The aim of this analysis was to evaluate outcomes of patients with complex anatomy treated with contemporary SEVs.MethodsData from patients undergoing TAVR with the Evolut R or PRO devices in the randomized SURTAVI and Continued Access Study, Low Risk Trial, Evolut R US Study and 34R addendum, and TAVR 2.0 Study, were combined and stratified according to degree of aortic root angulation (<40⁰, 40-49⁰, 50-59⁰, ≥60⁰). Baseline characteristics, procedural, 30-day and 1-year clinical outcomes were compared.ResultsThis analysis included 1428 patients comprised of 53% men, with an average age of 77.5±7.3 years (Table). Degree of AoV angulation did not differ by patient age (p=0.58) or sex (p=0.42). Implantation of ≥2 valves and use of post-dilation were not associated with degree of AoV. At 30 days post procedure, there was no association between degree of AoV angle and ≥ moderate paravalvular leak (p=0.17) or key clinical outcomes (p>0.05). At 1 year, there were no differences (p>0.05) in rates of all-cause mortality or reintervention among the AoV angle categories.ConclusionsDisclosuresT. Rogers: Medtronic: Advisory Board/Board Member and Consulting; Edwards Lifesciences: Consulting; Transmural Systems: Ownership Interests: Stocks, Stock Options; National Institutes of Health: Patent Holder/Intellectual Property Rights; J. K. Forrest: Medtronic: Consulting, grant support, Principal Investigator for a Research Study and Speaker Bureau; Edwards Lifesciences: Consulting, grant support and Speaker Bureau; W. Merhi: Medtronic: steering committee member; M. R. Williams: Medtronic: Research grants; Edwards Lifesciences: Research grants; T. K. Bajwa: Medtronic: Consulting; L. Lambrecht: Medtronic: Employed or Salary and Ownership Interests: Stocks, Stock Options; R. Eisenberg: Medtronic: Employed or Salary and Ownership Interests: Stocks, Stock Options; N. M. Van Mieghem: Boston Scientific Corp.: grant support; Abbott: grant support; Medtronic: grant support; Edwards Lifesciences: grant support; Abiomed: grant support; PulseCath BV: grant support; Daiichi Sankyo: grant support; M. J. Reardon: Abbott: Consulting and Principal Investigator for a Research Study; Boston Scientific Corp.: Consulting and Principal Investigator for a Research Study; Medtronic: Consulting and Principal Investigator for a Research Study; W.L. Gore and Associates, Inc.: Consulting and Principal Investigator for a Research Study; R. Waksman: Abbott: Advisory Board/Board Member and Consulting; AstraZeneca: Speaker Bureau; Biotronik: Consulting; Boston Scientific Corp.: Advisory Board/Board Member and Consulting; Cordis: Consulting; MedAlliance: Investor; Medtronic: Advisory Board/Board Member and Consulting; Philips: Advisory Board/Board Member and Consulting; Pi-Cardia LTD: Advisory Board/Board Member and Consulting; Swiss Interventional Systems / Sis Medical AG: Consulting; Transmural Systems, Inc.: Consulting; Venous MedTech: Consulting; BackgroundFor patients undergoing transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEV), greater aortoventricular (AoV) angulation has been identified as a technical challenge. However, it remains unclear if AoV angle affects early clinical outcomes. The aim of this analysis was to evaluate outcomes of patients with complex anatomy treated with contemporary SEVs. For patients undergoing transcatheter aortic valve replacement (TAVR) with self-expanding valves (SEV), greater aortoventricular (AoV) angulation has been identified as a technical challenge. However, it remains unclear if AoV angle affects early clinical outcomes. The aim of this analysis was to evaluate outcomes of patients with complex anatomy treated with contemporary SEVs. MethodsData from patients undergoing TAVR with the Evolut R or PRO devices in the randomized SURTAVI and Continued Access Study, Low Risk Trial, Evolut R US Study and 34R addendum, and TAVR 2.0 Study, were combined and stratified according to degree of aortic root angulation (<40⁰, 40-49⁰, 50-59⁰, ≥60⁰). Baseline characteristics, procedural, 30-day and 1-year clinical outcomes were compared. Data from patients undergoing TAVR with the Evolut R or PRO devices in the randomized SURTAVI and Continued Access Study, Low Risk Trial, Evolut R US Study and 34R addendum, and TAVR 2.0 Study, were combined and stratified according to degree of aortic root angulation (<40⁰, 40-49⁰, 50-59⁰, ≥60⁰). Baseline characteristics, procedural, 30-day and 1-year clinical outcomes were compared. ResultsThis analysis included 1428 patients comprised of 53% men, with an average age of 77.5±7.3 years (Table). Degree of AoV angulation did not differ by patient age (p=0.58) or sex (p=0.42). Implantation of ≥2 valves and use of post-dilation were not associated with degree of AoV. At 30 days post procedure, there was no association between degree of AoV angle and ≥ moderate paravalvular leak (p=0.17) or key clinical outcomes (p>0.05). At 1 year, there were no differences (p>0.05) in rates of all-cause mortality or reintervention among the AoV angle categories. This analysis included 1428 patients comprised of 53% men, with an average age of 77.5±7.3 years (Table). Degree of AoV angulation did not differ by patient age (p=0.58) or sex (p=0.42). Implantation of ≥2 valves and use of post-dilation were not associated with degree of AoV. At 30 days post procedure, there was no association between degree of AoV angle and ≥ moderate paravalvular leak (p=0.17) or key clinical outcomes (p>0.05). At 1 year, there were no differences (p>0.05) in rates of all-cause mortality or reintervention among the AoV angle categories. Conclusions DisclosuresT. Rogers: Medtronic: Advisory Board/Board Member and Consulting; Edwards Lifesciences: Consulting; Transmural Systems: Ownership Interests: Stocks, Stock Options; National Institutes of Health: Patent Holder/Intellectual Property Rights; J. K. Forrest: Medtronic: Consulting, grant support, Principal Investigator for a Research Study and Speaker Bureau; Edwards Lifesciences: Consulting, grant support and Speaker Bureau; W. Merhi: Medtronic: steering committee member; M. R. Williams: Medtronic: Research grants; Edwards Lifesciences: Research grants; T. K. Bajwa: Medtronic: Consulting; L. Lambrecht: Medtronic: Employed or Salary and Ownership Interests: Stocks, Stock Options; R. Eisenberg: Medtronic: Employed or Salary and Ownership Interests: Stocks, Stock Options; N. M. Van Mieghem: Boston Scientific Corp.: grant support; Abbott: grant support; Medtronic: grant support; Edwards Lifesciences: grant support; Abiomed: grant support; PulseCath BV: grant support; Daiichi Sankyo: grant support; M. J. Reardon: Abbott: Consulting and Principal Investigator for a Research Study; Boston Scientific Corp.: Consulting and Principal Investigator for a Research Study; Medtronic: Consulting and Principal Investigator for a Research Study; W.L. Gore and Associates, Inc.: Consulting and Principal Investigator for a Research Study; R. Waksman: Abbott: Advisory Board/Board Member and Consulting; AstraZeneca: Speaker Bureau; Biotronik: Consulting; Boston Scientific Corp.: Advisory Board/Board Member and Consulting; Cordis: Consulting; MedAlliance: Investor; Medtronic: Advisory Board/Board Member and Consulting; Philips: Advisory Board/Board Member and Consulting; Pi-Cardia LTD: Advisory Board/Board Member and Consulting; Swiss Interventional Systems / Sis Medical AG: Consulting; Transmural Systems, Inc.: Consulting; Venous MedTech: Consulting; T. Rogers: Medtronic: Advisory Board/Board Member and Consulting; Edwards Lifesciences: Consulting; Transmural Systems: Ownership Interests: Stocks, Stock Options; National Institutes of Health: Patent Holder/Intellectual Property Rights; J. K. Forrest: Medtronic: Consulting, grant support, Principal Investigator for a Research Study and Speaker Bureau; Edwards Lifesciences: Consulting, grant support and Speaker Bureau; W. Merhi: Medtronic: steering committee member; M. R. Williams: Medtronic: Research grants; Edwards Lifesciences: Research grants; T. K. Bajwa: Medtronic: Consulting; L. Lambrecht: Medtronic: Employed or Salary and Ownership Interests: Stocks, Stock Options; R. Eisenberg: Medtronic: Employed or Salary and Ownership Interests: Stocks, Stock Options; N. M. Van Mieghem: Boston Scientific Corp.: grant support; Abbott: grant support; Medtronic: grant support; Edwards Lifesciences: grant support; Abiomed: grant support; PulseCath BV: grant support; Daiichi Sankyo: grant support; M. J. Reardon: Abbott: Consulting and Principal Investigator for a Research Study; Boston Scientific Corp.: Consulting and Principal Investigator for a Research Study; Medtronic: Consulting and Principal Investigator for a Research Study; W.L. Gore and Associates, Inc.: Consulting and Principal Investigator for a Research Study; R. Waksman: Abbott: Advisory Board/Board Member and Consulting; AstraZeneca: Speaker Bureau; Biotronik: Consulting; Boston Scientific Corp.: Advisory Board/Board Member and Consulting; Cordis: Consulting; MedAlliance: Investor; Medtronic: Advisory Board/Board Member and Consulting; Philips: Advisory Board/Board Member and Consulting; Pi-Cardia LTD: Advisory Board/Board Member and Consulting; Swiss Interventional Systems / Sis Medical AG: Consulting; Transmural Systems, Inc.: Consulting; Venous MedTech: Consulting;