The Impact of Aortic Annular Geometry in Patients Undergoing Transcatheter Aortic Valve Implantation

Background: The aim of this study was to evaluate the shape of the aortic annulus in patients with aortic stenosis undergoing transcatheter aortic valve implantation (TAVI) and analyze its impact on periprocedural and short-term outcomes. The elliptical configuration of the native annulus, in contrast to the circular design of transcatheter valves, may lead to annular remodeling. We assessed complications such as conduction disturbances and paravalvular leakages while exploring how annular ellipticity affects outcomes.

Methods: From 2021 to 2023, 386 patients with aortic stenosis underwent TAVI at our institution. Aortic annulus geometry was assessed using multidetector computed tomography. After applying exclusion criteria—including valve-in-valve procedures, alternative approaches, and bicuspid aortic valve morphology—298 patients were analyzed. Annulus shape was quantified using the eccentricity index—ranging from 0 (perfectly circular) to 1 (completely elliptical). Clinical outcomes were defined according to the Valve Academic Research Consortium-3 criteria. Primary endpoints were technical success and a composite of hospital length of stay and 30-day mortality.

Results: Based on the eccentricity index, patients were divided into two groups: the first quantile (x > 0.68) representing the most elliptical anulus (n = 43), and the last quantile (x < 0.59) representing the most circular anulus (n = 51). Median age was 80.01 ± 7.09 years in the elliptical group versus 78.47 ± 7.92 years in the circular group (p = 0.32). Males comprised 62.78% of the elliptical group and 56.86% of the circular group (p = 0.564). Euroscore II was 4.4 ± 5.65% in the elliptical group and 2.98 ± 3.05% in the circular group (p = 0.077). Significant differences were observed in procedure time (43 ± 19.38 mins versus 34 ± 15.59 mins, p = 0.0148) and contrast agent usage (82.5 ± 47.49 mL versus 65 ± 32.28 mL, p = 0.03). No significant differences were found in paravalvular leakage (12.2% in the elliptical group versus 11.8% in the circular group, p = 0.95) or conduction disturbances (14.3% versus 9.8%, p = 0.518).

Conclusion: The elliptical configuration of the aortic annulus was associated with longer procedure times and higher contrast agent usage, suggesting increased technical complexity. However, no significant differences in key clinical outcomes such as paravalvular leakage or conduction disturbances were observed, indicating that procedural success is not compromised by annular shape.

Publication History

Article published online:
11 February 2025