Excessive canting of transcatheter heart valves (THV) significantly increases the risk of hypo-attenuated leaflet thickening (HALT) following transcatheter aortic valve replacement (TAVR). Data presented at the European Society of Cardiology (ESC) 2025 highlight how valve geometry influences long-term valve durability.

In a prospective study of 78 adults undergoing TAVR with self-expanding valves, HALT occurred in 33.3% of patients at 30 days. The deployment depth eccentricity index (DDEI), which measures THV canting, was an independent predictor of HALT (odds ratio 3.94, 95% confidence interval 2.08–7.44; P<0.001). Receiver operating characteristic analysis showed strong predictive performance (area under the curve 0.896, 95% CI 0.819–0.974). The elevated HALT risk persisted across subgroups regardless of anticoagulation, gender, valve type, or aortic regurgitation.

At six-month follow-up, HALT was associated with higher rates of stroke or transient ischemic attack (17.4% vs 0%, P=0.018) and increased mean pressure gradient (18.9 ± 10.1 mmHg vs 14.2 ± 7.5 mmHg, P=0.038). These findings suggest optimizing THV coaxiality and sizing may reduce HALT and improve prosthesis durability after TAVR.