Influence of the initial expansion position of balloon-expandable valves on valve distortion in transcatheter aortic valve implantation.

Transcatheter heart valve (THV) distortion is a commonly observed phenomenon during transcatheter aortic valve implantation (TAVI). However, the influence of the initial expansion position of the THV on its distortion has not been discussed. In a single-center study, patients who underwent TAVI with a balloon-expandable valve were enrolled. Patients were divided into the NCC (non-coronary cusp) group and the non-NCC group based on the initial position of valve expansion. The relationship between initial valve position and the degree of THV distortion was analyzed. Degree of THV distortion was defined as the "L/N ratio" (L: stent length on the left-coronary cusp (LCC) side; N: stent length on the NCC side). Furthermore, patients were also divided into distorted valve group and non-distorted valve group (distorted valve: L/N ratio < 0.95 or > 1.05). We also assessed the prognostic impact of initial valve position and THV distortion. Among a total of 116 patients, 72 patients were classified into NCC group and 44 patients into the non-NCC group. The NCC group had a significantly lower L/N ratio than the non-NCC group, indicating greater distortion in the NCC group (0.93 ± 0.06 vs. 0.99 ± 0.07, p < 0.01). There were no significant differences in three-year all-cause mortality or heart failure rehospitalization between the groups. Additionally, post-operative transthoracic echocardiography parameters showed no significant differences between the groups. The initial expansion position of the THV was associated with the valve distortion, which did not affect mid-term clinical outcomes following TAVI.