Aortic angulation (AA), defined as the angle between the horizontal plane on the coronal plane and the plane of the aortic valve annulus, is an important anatomical factor in transcatheter aortic valve replacement (TAVR). Whether AA affects early clinical outcomes and complications in self-expanding (SE)-TAVR procedures is still controversial.

We conducted a retrospective cohort study of 519 consecutive patients who underwent SE-TAVR at our centre from January 2016 to January 2021. Preoperative AA, technique success, and one-year postoperative survival rates were primarily analysed.

The AA of patients undergoing SE-TAVR ranged from 25° to 93°, with a mean value of 55.4°±9.7°. There was a statistically significant difference in technique success between AA≤55.5° and AA>55.5° groups (84.3% vs 75.1%, p=0.009), mainly driven by the higher proportion of second-valve implantation during TAVR (8.8% vs 19.6%, p<0.001). In valve-type subgroup analysis, larger AA demonstrated good predictive value for second-valve implantation (area under the curve 0.690; 95% confidence interval 0.617–0.763). However, AA showed limited predictive efficacy for technical success in patients with bicuspid aortic valve, and it was not associated with major complications or unplanned interventions in patients with tricuspid aortic valve.

A larger AA is associated with a lower rate of technical success of SE-TAVR, mainly due to an increased frequency of second-valve implantation. The impact of AA is more evident in patients with tricuspid aortic valve rather than in those with bicuspid aortic valve.