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 Jan;33(1):58-65. doi: 10.1007/s00380-017-1032-1. Epub 2017 Aug 10.

Abstract

Objectives: To evaluate the impact of the angles quantified by multidetector computed tomography (MDCT) between the ascending aorta's long axis and, the left ventricular inflow long axis (LVLA), or the left ventricule outflow tract long axis, and the occurrence of post-transcatheter aortic valve replacement (TAVR) aortic regurgitation (AR).

Methods: We prospectively included 136 consecutive patients who underwent a transfemoral TAVR with a preoperative MDCT. The groups were defined according to AR <2 or ≥2 assessed by echocardiography at 1 month.

Results: AR ≥2 identified in 21 patients (15.4%), was associated with increased rates of mortality (p value 0.02) and heart failure (p value 0.001) at 1-year follow-up. The aorta-LVLA angle was significantly higher in patients with AR ≥2 (130.5° ± 8.8° vs. 124.6° ± 9.5°; p = 0.009). On univariate analysis, aorta-LVLA angle was predictive of AR ≥2 [OR 1.07 per degree (1.02-1.13); p = 0.011]. After adjustment on annular calcification extent, the percentage of prosthesis-annular mismatch and the type of prosthesis, the relationship between aorta-LVLA angle and the risk of AR ≥2 remained unchanged.

Conclusions: We showed that increased angulation between the ascending aorta and the LVLA is associated with higher rates of AR post-TAVR independent of other potential correlates.

Keywords: Angulation; Aortic regurgitation; Aortic valve implantation; Computed tomography; Mortality.

MeSH terms

  • Aged, 80 and over
  • Aorta, Thoracic / diagnostic imaging*
  • Aorta, Thoracic / physiopathology
  • Aortic Valve Insufficiency / diagnosis
  • Aortic Valve Insufficiency / etiology*
  • Aortic Valve Insufficiency / mortality
  • Aortic Valve Stenosis / diagnosis
  • Aortic Valve Stenosis / surgery*
  • Blood Flow Velocity / physiology
  • Echocardiography, Transesophageal
  • Female
  • France / epidemiology
  • Heart Valve Prosthesis
  • Heart Ventricles / diagnostic imaging*
  • Heart Ventricles / physiopathology
  • Humans
  • Imaging, Three-Dimensional*
  • Male
  • Multidetector Computed Tomography / methods*
  • Postoperative Complications
  • Prospective Studies
  • Prosthesis Design
  • Survival Rate / trends
  • Transcatheter Aortic Valve Replacement / adverse effects*