TY - JOUR

T1 - Horizontal Aorta in Transcatheter Self-Expanding Valves

T2 - Insights from the HORSE International Multicentre Registry

AU - Gallo, Francesco

AU - Gallone, Guglielmo

AU - Kim, Won Keun

AU - Reifart, Jörg

AU - Veulemans, Verena

AU - Zeus, Tobias

AU - Toggweiler, Stefan

AU - De Backer, Ole

AU - Søndergaard, Lars

AU - Mangieri, Antonio

AU - Khokhar, Arif

AU - De Marco, Federico

AU - Regazzoli, Damiano

AU - Reimers, Bernhard

AU - Muntané-Carol, Guillem

AU - Estévez-Loureiro, Rodrigo

AU - Espino, Antonio

AU - Moscarelli, Marco

AU - Armario, Xavier

AU - Mylotte, Darren

AU - Gorla, Riccardo

AU - Bhadra, Oliver Daniel

AU - Conradi, Lenard

AU - Marroquin Donday, Luis Alfonso

AU - Nombela-Franco, Luis

AU - Barbanti, Marco

AU - Reddavid, Claudia

AU - Criscione, Enrico

AU - Brugaletta, Salvatore

AU - Regueiro, Ander

AU - Pérez-Fuentes, Pedro

AU - Nicolini, Elisa

AU - Piva, Tommaso

AU - Tzanis, Giorgos

AU - Rodes-Cabau, Josep

AU - Colombo, Antonio

AU - Giannini, Francesco

N1 - Publisher Copyright: © 2021 Lippincott Williams and Wilkins. All rights reserved.

PY - 2021

Y1 - 2021

N2 - Background: An increased degree of aortic angulation (AA) represents a challenging feature for bioprosthesis positioning. Whether AA has an impact on procedural outcomes of contemporary self-expanding valves remains unsettled. The aim of this study was to evaluate the impact of AA on procedural outcomes of transcatheter aortic valve replacement with contemporary self-expanding valves. Methods: The HORSE (Horizontal Aorta in Transcatheter Self-Expanding Valves) is an international, retrospective registry including 3862 consecutive patients undergoing transcatheter aortic valve replacement with either Evolut R/PRO (n=1959) or ACURATE neo (n=1903) devices. Patients undergoing Evolut R 34 mm implantation were excluded as no comparable prosthesis size for ACURATE neo is available. AA was evaluated with preprocedural computed tomography, and its impact on device success was evaluated. Results: In the overall population, AA did not have any impact upon device success, also when adjusting for in-study outcome predictors (odds ratio for 1° increment, 0.99 [95% CI, 0.98-1.01], P=0.306). However, increased AA was associated with lower device success with use of the Evolut R/PRO valves (odds ratio, 0.97 [95% CI, 0.95-0.99]; P=0.004), but not the ACURATE neo valves (odds ratio, 1.00 [95% CI, 0.98-1.03], P=0.304). The best AA cutoff value predicting device success was 49° (47% of the study cohort). Among patients with AA≥49°, Evolut R/PRO valves were associated with lower device success as compared to the ACURATE neo valve (inverse probability weighting odds ratio, 0.62 [95% CI, 0.46-0.83]; P=0.002). Conclusions: Horizontal aorta, as defined by an AA ≥49°, is a common feature among transcatheter aortic valve replacement candidates and predicts device failure of the Evolut R/PRO valves, but not of the ACURATE neo valve. AA may be an effect modifier of the association between self-expanding valve type and device success.

AB - Background: An increased degree of aortic angulation (AA) represents a challenging feature for bioprosthesis positioning. Whether AA has an impact on procedural outcomes of contemporary self-expanding valves remains unsettled. The aim of this study was to evaluate the impact of AA on procedural outcomes of transcatheter aortic valve replacement with contemporary self-expanding valves. Methods: The HORSE (Horizontal Aorta in Transcatheter Self-Expanding Valves) is an international, retrospective registry including 3862 consecutive patients undergoing transcatheter aortic valve replacement with either Evolut R/PRO (n=1959) or ACURATE neo (n=1903) devices. Patients undergoing Evolut R 34 mm implantation were excluded as no comparable prosthesis size for ACURATE neo is available. AA was evaluated with preprocedural computed tomography, and its impact on device success was evaluated. Results: In the overall population, AA did not have any impact upon device success, also when adjusting for in-study outcome predictors (odds ratio for 1° increment, 0.99 [95% CI, 0.98-1.01], P=0.306). However, increased AA was associated with lower device success with use of the Evolut R/PRO valves (odds ratio, 0.97 [95% CI, 0.95-0.99]; P=0.004), but not the ACURATE neo valves (odds ratio, 1.00 [95% CI, 0.98-1.03], P=0.304). The best AA cutoff value predicting device success was 49° (47% of the study cohort). Among patients with AA≥49°, Evolut R/PRO valves were associated with lower device success as compared to the ACURATE neo valve (inverse probability weighting odds ratio, 0.62 [95% CI, 0.46-0.83]; P=0.002). Conclusions: Horizontal aorta, as defined by an AA ≥49°, is a common feature among transcatheter aortic valve replacement candidates and predicts device failure of the Evolut R/PRO valves, but not of the ACURATE neo valve. AA may be an effect modifier of the association between self-expanding valve type and device success.

KW - aortic valve

KW - bioprosthesis

KW - registry

KW - tomography

KW - transcatheter aortic valve replacement

U2 - 10.1161/CIRCINTERVENTIONS.121.010641

DO - 10.1161/CIRCINTERVENTIONS.121.010641

M3 - Journal article

C2 - 34455799

AN - SCOPUS:85116195009

VL - 14

JO - Circulation: Cardiovascular Interventions

JF - Circulation: Cardiovascular Interventions

SN - 1941-7640

IS - 9

M1 - e010641

ER -