Anatomic and procedural associations of transcatheter heart valve displacement following Evolut R implantation

Objectives: This study aimed to predict the displacement of self-expanding transcatheter heart valves (THV) during final deployment. Background: Accurate device positioning during transcatheter aortic valve implantation (TAVI) is crucial for optimal results. Methods: At our institution, 103 patients who underwent transfemoral TAVI with Evolut R were retrospectively identified. Multiple linear regression models were created, and a predictor equation was built to quantify the factors that may affect THV behavior. Results: Multiple linear regression analysis for THV displacement on the left coronary cusp (LCC) identified the angle between the THV and the ascending aorta (ATA), predilation, and less operator experience as independent predictors of upward displacement, whereas estimated glomerular filtration rate (eGFR) was inversely related with THV behavior (95% confidence interval: 0.219 to 0.340, 0.447 to 2.092, 0.165 to 1.757, and −0.053 to −0.011, respectively). Predictors of THV displacement on the noncoronary cusp side could not be identified using this model. Conclusions: The ATA at the point of recapture, predilation, and less operator experience were independent predictors of upward displacement of THV on the LCC side. eGFR was an independent predictor of THV downward displacement on the LCC side. Of them, the ATA was the strongest predictor. Physicians may need to adjust this angle adequately before deployment to achieve the appropriate position.