The anatomy is the plastic image of function: the role of the ventricle-aortic angle in TAVR.

The horizontal aorta of 51° or more, dilated annulus and severe asymmetric calcifications result the three anatomical key features in predicting worse outcome after transfemoral TAVR with the new iterations of self-expandable devices. These findings further validate the ESC guidelines on the importance of anatomical factors in favoring TAVR or surgical aortic valve replacement. Future trials on head to head comparison between valves and on the role of ancillary devices are important to refine final decision making of the heart team on the type of aortic valve replacement and type of valve.