Abstract 535: Steepening Left Ventricle to Aortic Root Angle is Associated With Increasing Age and Basal Septal Thickness: Implications for Percutaneous Aortic Valve Replacement
Background: Transcatheter aortic valve implantation (TAVI) is a new therapy in patients with severe aortic stenosis (AS). On multi-detector computed tomographic angiography (MDCTA), we noted variation in left ventricle to aortic root angle (LVARA, Figure A–B⇓), with older AS patients having a steeper angle (Figure B⇓). During TAVI, steep LVARA may not allow coaxial delivery of the valve, potentially increasing chances of malpositioning. We sought to discern the predictors of steep LVARA.
Methods: We included 90 controls ≤ 65 years, that had a standard 64-MDCTA (Siemens, 0.75 mm slice thickness, 90 cc Ultravist 370), with no obstructive coronary artery disease. We also studied 21 patients with severe AS undergoing 64-MDCTA for TAVI. End-diastolic basal septal thickness (BST) was recorded. There was no aortic or LV dilation.
Results: There was a significant difference in age (80 ± 9 vs. 46 ± 10 years), hypertension (100 % vs. 23 %), LVARA (122° ± 3 vs. 134° ± 9, p < 0.001) and BST (1.7 ± 0.3 vs. 1.2 ± 0.3, p < 0.001) between AS and control groups (all p < 0.001), while gender was similar (41 % vs. 38 % men, p = 0.8). In controls, predictors of LVARA are shown in Table⇓.
Conclusions: LVARA steepens with increasing age and BST. Older patients with severe AS have steeper LVARA compared to younger patients. A priori knowledge of steep LVARA might aid in optimal deployment of prosthesis during TAVI (including transapically).