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.
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.
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Authors: Martin B Leon; Craig R Smith; Michael J Mack; Raj R Makkar; Lars G Svensson; Susheel K Kodali; Vinod H Thourani; E Murat Tuzcu; D Craig Miller; Howard C Herrmann; Darshan Doshi; David J Cohen; Augusto D Pichard; Samir Kapadia; Todd Dewey; Vasilis Babaliaros; Wilson Y Szeto; Mathew R Williams; Dean Kereiakes; Alan Zajarias; Kevin L Greason; Brian K Whisenant; Robert W Hodson; Jeffrey W Moses; Alfredo Trento; David L Brown; William F Fearon; Philippe Pibarot; Rebecca T Hahn; Wael A Jaber; William N Anderson; Maria C Alu; John G Webb Journal: N Engl J Med Date: 2016-04-02 Impact factor: 91.245
Authors: Martin B Leon; Nicolo Piazza; Eugenia Nikolsky; Eugene H Blackstone; Donald E Cutlip; Arie Pieter Kappetein; Mitchell W Krucoff; Michael Mack; Roxana Mehran; Craig Miller; Marie-Angèle Morel; John Petersen; Jeffrey J Popma; Johanna J M Takkenberg; Alec Vahanian; Gerrit-Anne van Es; Pascal Vranckx; John G Webb; Stephan Windecker; Patrick W Serruys Journal: Eur Heart J Date: 2011-01-06 Impact factor: 29.983