# The influence of different transcatheter aortic valve implantation angles, as assessed by multidetector spiral CT scanning, on the depth of valve implantation and its impact on clinical prognosis

## TL;DR

This study shows that misaligned valve implantation angles during TAVI lead to deeper implantation and worse outcomes, including complications and lower quality of life.

## Contribution

The study introduces a novel MSCT-based method to assess commissural alignment's impact on TAVI outcomes.

## Key findings

- Misaligned TAVI implantation was linked to deeper valve placement and higher complication rates.
- Aligned implantation improved early quality of life scores in patients.
- Commissural misalignment increased risks of paravalvular leakage and valve dislocation.

## Abstract

This study aimed to investigate the impact of commissural alignment on transcatheter aortic valve implantation (TAVI) depth and clinical outcomes using multidetector spiral computed tomography (MSCT) assessment.

In a retrospective cohort of 215 high-surgical-risk aortic stenosis (AS) patients undergoing TAVI (April 2020–March 2024), patients were stratified into Aligned (0–30° commissural offset, n = 106) and Misaligned (>30° offset, n = 109) groups based on pre/post-procedural MSCT. Primary endpoints included implantation depth, [left ventricular ejection fraction (LVEF)], 30-days complications, and quality of life [Toronto Aortic Stenosis Quality of Life questionnaire (TASQ)].

Misaligned patients exhibited lower implantation depths at non-coronary (7.15 ± 0.53 mm vs. 6.95 ± 0.81 mm, p = 0.035) and left coronary cusps (5.21 ± 0.64 mm vs. 4.92 ± 0.41 mm, p < 0.001), with higher rates of deep implantation (>10 mm: 9.17% vs. 1.89%, p = 0.020). Misalignment increased complications: paravalvular leakage (19.27% vs. 6.60%, p = 0.006), pacemaker implantation (11.93% vs. 3.77%, p = 0.027), and valve dislocation (15.60% vs. 5.66%, p = 0.018). Aligned patients reported better 1-month TASQ scores (76.65 ± 17.31 vs. 69.85 ± 16.41, p = 0.003), particularly in physical limitations (p = 0.004) and emotional impact (p = 0.013).

Commissural misalignment was associated with deeper valve implantation, higher complication rates, and reduced early quality of life. Precise angular alignment could optimize TAVI outcomes, potentially by improving implantation depth consistency and reducing early adverse events.