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

Purpose 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. Methods 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)]. Results 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). Conclusion 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.