Impact of Horizontal Aorta in Self-Expanding TAVR Implantation: Insights from the HORSE International Multicenter Registry

Background: The aim of this study was to evaluate the impact of aortic angulation (AA) on procedural outcomes of transcatheter aortic valve implantation (TAVI) with contemporary self-expanding (SE) transcatheter heart valves (THV). An increased degree of AA is associated with challenging THV placement. Whether AA has an impact on procedural outcomes of SE TAVI remains uncertain.

Method: The HORSE (Horizontal Aorta in Transcatheter Self-Expanding Valves) is an international, retrospective registry including 3,862 consecutive patients undergoing TAVI with either EvolutR/PRO (n = 1,959) or ACURATE neo (n = 1,903) THV. Patients receiving 34 mm EvolutR THV 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 THV (odds ratio, 0.97 [95% CI, 0.95–0.99]; p = 0.004), but not the ACURATE neo THV (odds ratio, 1.00 [95% CI, 0.98–1.03], p = 0.304). The best AA cut-off value predicting device success was 49° (47% of the study cohort). Among patients with AA ≥ 49 degrees, Evolut R/PRO THV were associated with lower device success as compared with the ACURATE neo THV (inverse probability weighting odds ratio, 0.62 [95% CI, 0.46–0.83]; p = 0.002).

Conclusion: Horizontal aorta, as defined by an AA ≥49°, is a common feature among TAVI candidates and predicts device failure of the Evolut R/PRO THV, but not of the ACURATE neo THV. AA should be taken into account when allocating patients to different SE THV types.

No conflict of interest has been declared by the author(s).

Publication History

Article published online:
03 February 2022