Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement

Marco Moscarelli; Francesco Gallo; Guglielmo Gallone; Won-Keun Kim; Jörg Reifart; Verena Veulemans; Tobias Zeus; Stefan Toggweiler; Ole De Backer; Lars Søndergaard; Antonio Mangieri; Federico De Marco; Damiano Regazzoli; Bernhard Reimers; Guillem Muntané-Carol; Rodrigo Estevez Lauriero; Xavier Armario; Darren Mylotte; Oliver Daniel Bhadra; Lenard Conradi; Luis Alfonso Marroquin Donday; Luis Nombela-Franco; Marco Barbanti; Claudia Reddavid; Salvatore Brugaletta; Elisa Nicolini; Giorgos Tzanis; Josep Rodes-Cabau; Antonio Colombo; Francesco Giannini

doi:10.1016/j.ijcard.2021.05.054

Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement

Marco Moscarelli, Francesco Gallo, Guglielmo Gallone, Won-Keun Kim, Jörg Reifart, Verena Veulemans, Tobias Zeus, Stefan Toggweiler, Ole De Backer, Lars Søndergaard, Antonio Mangieri, Federico De Marco, Damiano Regazzoli, Bernhard Reimers, Guillem Muntané-Carol, Rodrigo Estevez Lauriero, Xavier Armario, Darren Mylotte, Oliver Daniel Bhadra, Lenard ConradiLuis Alfonso Marroquin Donday, Luis Nombela-Franco, Marco Barbanti, Claudia Reddavid, Salvatore Brugaletta, Elisa Nicolini, Giorgos Tzanis, Josep Rodes-Cabau, Antonio Colombo, Francesco Giannini

Research output: Contribution to journal › Article › peer-review

Abstract

BACKGROUND: Horizontal aorta (HA) is an anatomical feature that can pose significant technical challenges for the successful positioning of the bioprosthetic valve during transcatheter aortic valve replacement (TAVR). Physiological range of aortic angle (AA) is unknown; hence there is no cutoff AA for classifying HA. Moreover, patient characteristics predicting HA are under-investigated.

METHODS: This was a retrospective analysis of prospective collected data from 16 heart valve centers in Europe. The study utilized a common dataset with a priori agreed-upon definitions and variables. Eligible patients underwent TAVR between 2014 and 2020 and had multidetector computed tomographic imaging data available for determining the AA. The analysis described the distribution of AA and potential predictors of HA. Inter-center variability was also explored.

RESULTS: For 4022 patients analyzed, the mean AA ± standard deviation was 49.4° ± 9.4° (median 49°, inter-quartile range [IQR] 12°, range 18-90°). There was no significant difference in mean AA between men and women (49.4° ± 9.1° vs. 49.6° ± 9.3°, respectively; p = 0.53); therefore, 49.4° was accepted as the cutoff value for HA in subsequent analyses. Covariates significantly associated with HA included age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.04, p < 0.001), body mass index (OR: 1.06, 95% CI: 1.05-1.08, p < 0.01), previous cardiac surgery (OR: 0.58, 95% CI: 0.45-0.75, p < 0.001), and porcelain aorta (OR: 0.66, 95% CI: 0.52-0.85, p = 0.001). Some inter-center variability was observed.

CONCLUSIONS: We defined 49.4° as the mean AA, and also associated predictors of HA in a large case series of patients with severe aortic stenosis candidates for TAVR.

Original language	English
Pages (from-to)	58-62
Number of pages	5
Journal	Int. J. Cardiol.
Volume	338
DOIs	https://doi.org/10.1016/j.ijcard.2021.05.054
Publication status	Published - Sept 1 2021

Keywords

Aorta
Aortic Valve/diagnostic imaging
Aortic Valve Stenosis/diagnostic imaging
Europe
Female
Humans
Male
Prospective Studies
Retrospective Studies
Risk Factors
Severity of Illness Index
Transcatheter Aortic Valve Replacement/adverse effects
Treatment Outcome

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10.1016/j.ijcard.2021.05.054

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Moscarelli, M., Gallo, F., Gallone, G., Kim, W-K., Reifart, J., Veulemans, V., Zeus, T., Toggweiler, S., De Backer, O., Søndergaard, L., Mangieri, A., De Marco, F., Regazzoli, D., Reimers, B., Muntané-Carol, G., Lauriero, R. E., Armario, X., Mylotte, D., Bhadra, O. D., ... Giannini, F. (2021). Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement. Int. J. Cardiol., 338, 58-62. https://doi.org/10.1016/j.ijcard.2021.05.054

Moscarelli, M, Gallo, F, Gallone, G, Kim, W-K, Reifart, J, Veulemans, V, Zeus, T, Toggweiler, S, De Backer, O, Søndergaard, L, Mangieri, A, De Marco, F, Regazzoli, D, Reimers, B, Muntané-Carol, G, Lauriero, RE, Armario, X, Mylotte, D, Bhadra, OD, Conradi, L, Donday, LAM, Nombela-Franco, L, Barbanti, M, Reddavid, C, Brugaletta, S, Nicolini, E, Tzanis, G, Rodes-Cabau, J, Colombo, A & Giannini, F 2021, 'Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement', Int. J. Cardiol., vol. 338, pp. 58-62. https://doi.org/10.1016/j.ijcard.2021.05.054

@article{7f01ec65928549e8bb8f8b8c9c464b55,

title = "Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement",

abstract = "BACKGROUND: Horizontal aorta (HA) is an anatomical feature that can pose significant technical challenges for the successful positioning of the bioprosthetic valve during transcatheter aortic valve replacement (TAVR). Physiological range of aortic angle (AA) is unknown; hence there is no cutoff AA for classifying HA. Moreover, patient characteristics predicting HA are under-investigated.METHODS: This was a retrospective analysis of prospective collected data from 16 heart valve centers in Europe. The study utilized a common dataset with a priori agreed-upon definitions and variables. Eligible patients underwent TAVR between 2014 and 2020 and had multidetector computed tomographic imaging data available for determining the AA. The analysis described the distribution of AA and potential predictors of HA. Inter-center variability was also explored.RESULTS: For 4022 patients analyzed, the mean AA ± standard deviation was 49.4° ± 9.4° (median 49°, inter-quartile range [IQR] 12°, range 18-90°). There was no significant difference in mean AA between men and women (49.4° ± 9.1° vs. 49.6° ± 9.3°, respectively; p = 0.53); therefore, 49.4° was accepted as the cutoff value for HA in subsequent analyses. Covariates significantly associated with HA included age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.04, p < 0.001), body mass index (OR: 1.06, 95% CI: 1.05-1.08, p < 0.01), previous cardiac surgery (OR: 0.58, 95% CI: 0.45-0.75, p < 0.001), and porcelain aorta (OR: 0.66, 95% CI: 0.52-0.85, p = 0.001). Some inter-center variability was observed.CONCLUSIONS: We defined 49.4° as the mean AA, and also associated predictors of HA in a large case series of patients with severe aortic stenosis candidates for TAVR.",

keywords = "Aorta, Aortic Valve/diagnostic imaging, Aortic Valve Stenosis/diagnostic imaging, Europe, Female, Humans, Male, Prospective Studies, Retrospective Studies, Risk Factors, Severity of Illness Index, Transcatheter Aortic Valve Replacement/adverse effects, Treatment Outcome",

author = "Marco Moscarelli and Francesco Gallo and Guglielmo Gallone and Won-Keun Kim and J{\"o}rg Reifart and Verena Veulemans and Tobias Zeus and Stefan Toggweiler and {De Backer}, Ole and Lars S{\o}ndergaard and Antonio Mangieri and {De Marco}, Federico and Damiano Regazzoli and Bernhard Reimers and Guillem Muntan{\'e}-Carol and Lauriero, {Rodrigo Estevez} and Xavier Armario and Darren Mylotte and Bhadra, {Oliver Daniel} and Lenard Conradi and Donday, {Luis Alfonso Marroquin} and Luis Nombela-Franco and Marco Barbanti and Claudia Reddavid and Salvatore Brugaletta and Elisa Nicolini and Giorgos Tzanis and Josep Rodes-Cabau and Antonio Colombo and Francesco Giannini",

year = "2021",

month = sep,

day = "1",

doi = "10.1016/j.ijcard.2021.05.054",

language = "English",

volume = "338",

pages = "58--62",

journal = "Int. J. Cardiol.",

issn = "0167-5273",

publisher = "Elsevier Ireland Ltd",

}

TY - JOUR

T1 - Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement

AU - Moscarelli, Marco

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 - De Marco, Federico

AU - Regazzoli, Damiano

AU - Reimers, Bernhard

AU - Muntané-Carol, Guillem

AU - Lauriero, Rodrigo Estevez

AU - Armario, Xavier

AU - Mylotte, Darren

AU - Bhadra, Oliver Daniel

AU - Conradi, Lenard

AU - Donday, Luis Alfonso Marroquin

AU - Nombela-Franco, Luis

AU - Barbanti, Marco

AU - Reddavid, Claudia

AU - Brugaletta, Salvatore

AU - Nicolini, Elisa

AU - Tzanis, Giorgos

AU - Rodes-Cabau, Josep

AU - Colombo, Antonio

AU - Giannini, Francesco

PY - 2021/9/1

Y1 - 2021/9/1

N2 - BACKGROUND: Horizontal aorta (HA) is an anatomical feature that can pose significant technical challenges for the successful positioning of the bioprosthetic valve during transcatheter aortic valve replacement (TAVR). Physiological range of aortic angle (AA) is unknown; hence there is no cutoff AA for classifying HA. Moreover, patient characteristics predicting HA are under-investigated.METHODS: This was a retrospective analysis of prospective collected data from 16 heart valve centers in Europe. The study utilized a common dataset with a priori agreed-upon definitions and variables. Eligible patients underwent TAVR between 2014 and 2020 and had multidetector computed tomographic imaging data available for determining the AA. The analysis described the distribution of AA and potential predictors of HA. Inter-center variability was also explored.RESULTS: For 4022 patients analyzed, the mean AA ± standard deviation was 49.4° ± 9.4° (median 49°, inter-quartile range [IQR] 12°, range 18-90°). There was no significant difference in mean AA between men and women (49.4° ± 9.1° vs. 49.6° ± 9.3°, respectively; p = 0.53); therefore, 49.4° was accepted as the cutoff value for HA in subsequent analyses. Covariates significantly associated with HA included age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.04, p < 0.001), body mass index (OR: 1.06, 95% CI: 1.05-1.08, p < 0.01), previous cardiac surgery (OR: 0.58, 95% CI: 0.45-0.75, p < 0.001), and porcelain aorta (OR: 0.66, 95% CI: 0.52-0.85, p = 0.001). Some inter-center variability was observed.CONCLUSIONS: We defined 49.4° as the mean AA, and also associated predictors of HA in a large case series of patients with severe aortic stenosis candidates for TAVR.

AB - BACKGROUND: Horizontal aorta (HA) is an anatomical feature that can pose significant technical challenges for the successful positioning of the bioprosthetic valve during transcatheter aortic valve replacement (TAVR). Physiological range of aortic angle (AA) is unknown; hence there is no cutoff AA for classifying HA. Moreover, patient characteristics predicting HA are under-investigated.METHODS: This was a retrospective analysis of prospective collected data from 16 heart valve centers in Europe. The study utilized a common dataset with a priori agreed-upon definitions and variables. Eligible patients underwent TAVR between 2014 and 2020 and had multidetector computed tomographic imaging data available for determining the AA. The analysis described the distribution of AA and potential predictors of HA. Inter-center variability was also explored.RESULTS: For 4022 patients analyzed, the mean AA ± standard deviation was 49.4° ± 9.4° (median 49°, inter-quartile range [IQR] 12°, range 18-90°). There was no significant difference in mean AA between men and women (49.4° ± 9.1° vs. 49.6° ± 9.3°, respectively; p = 0.53); therefore, 49.4° was accepted as the cutoff value for HA in subsequent analyses. Covariates significantly associated with HA included age (odds ratio [OR]: 1.02, 95% confidence interval [CI]: 1.01-1.04, p < 0.001), body mass index (OR: 1.06, 95% CI: 1.05-1.08, p < 0.01), previous cardiac surgery (OR: 0.58, 95% CI: 0.45-0.75, p < 0.001), and porcelain aorta (OR: 0.66, 95% CI: 0.52-0.85, p = 0.001). Some inter-center variability was observed.CONCLUSIONS: We defined 49.4° as the mean AA, and also associated predictors of HA in a large case series of patients with severe aortic stenosis candidates for TAVR.

KW - Aorta

KW - Aortic Valve/diagnostic imaging

KW - Aortic Valve Stenosis/diagnostic imaging

KW - Europe

KW - Female

KW - Humans

KW - Male

KW - Prospective Studies

KW - Retrospective Studies

KW - Risk Factors

KW - Severity of Illness Index

KW - Transcatheter Aortic Valve Replacement/adverse effects

KW - Treatment Outcome

U2 - 10.1016/j.ijcard.2021.05.054

DO - 10.1016/j.ijcard.2021.05.054

M3 - Article

C2 - 34090956

SN - 0167-5273

VL - 338

SP - 58

EP - 62

JO - Int. J. Cardiol.

JF - Int. J. Cardiol.

ER -

Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement

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