Aortic angle in predicting aortic regurgitation after transcatheter aortic valve implantation

Objectives: The primary aim of the study was to evaluate the effect of the aortic angle on aortic regurgitation after transcatheter aortic valve implantation (TAVI), while secondary objectives involved exploring correlations between the aortic angle and various clinical and demographic factors. Patients and methods: The single-center observational study included 105 patients (55 females, 50 males; mean age: 78.8±6.7 years; range, 70 to 92 years) who underwent TAVI between October 2019 and September 2023. Comprehensive preprocedural evaluations were conducted, including echocardiography and computed tomography. Evolut R self-expandable supra-annular valves were used in the procedures. Results: Hypertension (85.7%) and atrial fibrillation (78.2%) were the most common comorbidities, and 14.3% of patients exhibited moderate aortic regurgitation before TAVI. The mean aortic angle was 46.8±10.6° before the procedure. In receiver operating characteristic analysis, the aortic angle affecting aortic regurgitation after TAVI was determined as 49.5°. After TAVI, significant reductions in pulmonary artery pressures and aortic regurgitation prevalence were observed. Aortic regurgitation decreased in 38.1% of patients, remained unchanged in 47.6% of patients, and increased in 14.3% of patients. A weak linear relationship (R2=0.011) was observed between aortic insufficiency and the aortic angle. Conclusion: The study showed that an aortic angle of 49.5° can be used to predict aortic regurgitation after TAVI. However, a weak linear correlation was detected between the aortic angle and aortic regurgitation.