{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T05:20:20Z","timestamp":1788326420446,"version":"build-2803163510"},"reference-count":32,"publisher":"MDPI AG","issue":"17","license":[{"start":{"date-parts":[[2026,8,29]],"date-time":"2026-08-29T00:00:00Z","timestamp":1787961600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Noncommunicable Chronic Diseases-National Science and Technology Major Project","award":["2024ZD0527100"],"award-info":[{"award-number":["2024ZD0527100"]}]},{"name":"Healthy Zhejiang One Million People Cohort","award":["K-20230085"],"award-info":[{"award-number":["K-20230085"]}]},{"name":"National Science Fund for Distinguished Young Scholars of China","award":["82425007"],"award-info":[{"award-number":["82425007"]}]},{"DOI":"10.13039\/501100001809","name":"The National Natural Science Foundation of China","doi-asserted-by":"crossref","award":["82271606"],"award-info":[{"award-number":["82271606"]}],"id":[{"id":"10.13039\/501100001809","id-type":"DOI","asserted-by":"crossref"}]},{"award":["82271606"],"award-info":[{"award-number":["82271606"]}],"id":[{"id":"https:\/\/ror.org\/01h0zpd94","id-type":"ROR","asserted-by":"publisher"}]},{"name":"Zhejiang Province Science and Technology Department Key R&D Program","award":["2022C03063"],"award-info":[{"award-number":["2022C03063"]}]},{"name":"Zhejiang Province Science and Technology Innovation Leading Talents Project","award":["2023R5236"],"award-info":[{"award-number":["2023R5236"]}]},{"name":"State Key Laboratory of Transvascular Implantation Devices"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["J. Clin. Med.","JCM"],"abstract":"<jats:p>Background\/Objectives: Horizontal aorta, characterized by a high aortic angle, represents a challenging anatomical feature during transcatheter aortic valve replacement (TAVR), but its association with cerebral ischemic injury remains unclear. This study investigated the association between horizontal aorta and diffusion-weighted magnetic resonance imaging (DW-MRI)-detected cerebral infarctions after TAVR. Methods: We retrospectively enrolled 411 consecutive patients with severe aortic stenosis undergoing transfemoral self-expanding TAVR between March 2017 and May 2022. Aortic angle was defined as the angle between the aortic annular plane and the horizontal plane on preprocedural computed tomography, and horizontal aorta was defined as an aortic angle &gt; 60\u00b0. Patients were categorized into horizontal aorta and non-horizontal aorta groups. The incidence, number, and volume of new DW-MRI lesions were compared between groups. Results: The median age was 74.0 years (interquartile range [IQR]: 69.0 to 79.0); 54.5% were male, and the median Society of Thoracic Surgeons score was 3.83% (IQR: 2.29 to 6.39). Horizontal aorta was present in 69 patients (16.8%). Procedural complications were infrequent and comparable between groups. Although the incidence of new cerebral infarctions was similar between groups (89.9% vs. 83.0%; p = 0.157), patients with horizontal aorta had more cerebral infarction lesions (median, 4.0 vs. 3.0; p = 0.031), larger total lesion volume (320.0 vs. 180.0 mm3; p = 0.017), and larger lesion volume per infarction (70.0 vs. 51.7 mm3; p = 0.036). Multivariable analysis identified horizontal aorta as an independent predictor of the number of post-TAVR cerebral infarctions. Conclusions: Horizontal aorta is relatively common among patients undergoing TAVR and is independently associated with a greater burden of DW-MRI-detected subclinical cerebral ischemic injury.<\/jats:p>","DOI":"10.3390\/jcm15176715","type":"journal-article","created":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T05:45:13Z","timestamp":1788241513000},"page":"6715","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Cerebral Infarctions After Transcatheter Aortic Valve Replacement of Horizontal Aorta Versus Non-Horizontal Aorta"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-7782-891X","authenticated-orcid":false,"given":"Hanyi","family":"Dai","sequence":"first","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China"},{"name":"Heart Regeneration and Repair Key Laboratory of Zhejiang Province, Hangzhou 310009, China"},{"name":"Transvascular Implantation Devices Research Institute, Hangzhou 310053, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7815-9490","authenticated-orcid":false,"given":"Dao","family":"Zhou","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China"},{"name":"Heart Regeneration and Repair Key Laboratory of Zhejiang Province, Hangzhou 310009, China"},{"name":"Transvascular Implantation Devices Research Institute, Hangzhou 310053, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Wenjing","family":"Sheng","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China"},{"name":"Heart Regeneration and Repair Key Laboratory of Zhejiang Province, Hangzhou 310009, China"},{"name":"Transvascular Implantation Devices Research Institute, Hangzhou 310053, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"given":"Rongrong","family":"Zheng","sequence":"additional","affiliation":[{"name":"Hangzhou Emergency Medical Center of Zhejiang Province, Hangzhou 310021, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"given":"Jun","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8733-3585","authenticated-orcid":false,"given":"Abuduwufuer","family":"Yidilisi","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1556-9198","authenticated-orcid":false,"given":"Xianbao","family":"Liu","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China"},{"name":"Heart Regeneration and Repair Key Laboratory of Zhejiang Province, Hangzhou 310009, China"},{"name":"Transvascular Implantation Devices Research Institute, Hangzhou 310053, China"},{"name":"Binjiang Institute, Zhejiang University, Hangzhou 310052, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"data-curation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"},{"role":"project-administration","vocabulary":"credit"},{"role":"funding-acquisition","vocabulary":"credit"}]},{"given":"Lihan","family":"Wang","sequence":"additional","affiliation":[{"name":"Department of Cardiology, The Second Affiliated Hospital, School of Medicine, Zhejiang University, Hangzhou 310009, China"},{"name":"State Key Laboratory of Transvascular Implantation Devices, Hangzhou 310009, China"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,8,29]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"1706","DOI":"10.1056\/NEJMoa1816885","article-title":"Transcatheter Aortic-Valve Replacement with a Self-Expanding Valve in Low-Risk Patients","volume":"380","author":"Popma","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"1695","DOI":"10.1056\/NEJMoa1814052","article-title":"Transcatheter Aortic-Valve Replacement with a Balloon-Expandable Valve in Low-Risk Patients","volume":"380","author":"Mack","year":"2019","journal-title":"N. Engl. J. Med."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"561","DOI":"10.1093\/eurheartj\/ehab395","article-title":"2021 ESC\/EACTS Guidelines for the management of valvular heart disease","volume":"43","author":"Vahanian","year":"2022","journal-title":"Eur. Heart J."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"450","DOI":"10.1016\/j.jacc.2020.11.035","article-title":"2020 ACC\/AHA Guideline for the Management of Patients With Valvular Heart Disease: Executive Summary: A Report of the American College of Cardiology\/American Heart Association Joint Committee on Clinical Practice Guidelines","volume":"77","author":"Otto","year":"2021","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"1808","DOI":"10.1016\/j.jcin.2022.06.033","article-title":"Management and Outcome of Acute Ischemic Stroke Complicating Transcatheter Aortic Valve Replacement","volume":"15","author":"Levi","year":"2022","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"673","DOI":"10.1016\/j.jacc.2016.05.065","article-title":"Predictors of Early Cerebrovascular Events in Patients With Aortic Stenosis Undergoing Transcatheter Aortic Valve Replacement","volume":"68","author":"Auffret","year":"2016","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"e002981","DOI":"10.1161\/CIRCINTERVENTIONS.115.002981","article-title":"Insights Into Timing, Risk Factors, and Outcomes of Stroke and Transient Ischemic Attack After Transcatheter Aortic Valve Replacement in the PARTNER Trial (Placement of Aortic Transcatheter Valves)","volume":"9","author":"Kapadia","year":"2016","journal-title":"Circ. Cardiovasc. Interv."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1016\/j.ijcard.2016.06.143","article-title":"Silent cerebral injury after transcatheter aortic valve implantation and the preventive role of embolic protection devices: A systematic review and meta-analysis","volume":"221","author":"Pagnesi","year":"2016","journal-title":"Int. J. Cardiol."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"1427","DOI":"10.1161\/STROKEAHA.107.502989","article-title":"Cerebral ischemic lesions on diffusion-weighted imaging are associated with neurocognitive decline after cardiac surgery","volume":"39","author":"Barber","year":"2008","journal-title":"Stroke"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"88","DOI":"10.1016\/j.ejcts.2005.02.043","article-title":"Small ischemic brain lesions after cardiac valve replacement detected by diffusion-weighted magnetic resonance imaging: Relation to neurocognitive function","volume":"28","author":"Knipp","year":"2005","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1253","DOI":"10.1056\/NEJMoa2204961","article-title":"Cerebral Embolic Protection during Transcatheter Aortic-Valve Replacement","volume":"387","author":"Kapadia","year":"2022","journal-title":"N. Engl. J. Med."},{"key":"ref_12","first-page":"301","article-title":"Computed Tomography Assessment for Transcatheter Aortic Valve Replacement","volume":"7","author":"Alkhouli","year":"2018","journal-title":"Interv. Cardiol. Clin."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1623","DOI":"10.1016\/j.jacc.2010.06.035","article-title":"Anatomic and procedural predictors of paravalvular aortic regurgitation after implantation of the Medtronic CoreValve bioprosthesis","volume":"56","author":"Sherif","year":"2010","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.ijcard.2021.05.054","article-title":"Aortic angle distribution and predictors of horizontal aorta in patients undergoing transcatheter aortic valve replacement","volume":"338","author":"Moscarelli","year":"2021","journal-title":"Int. J. Cardiol."},{"key":"ref_15","first-page":"E135","article-title":"Impact of aortic angle on transcatheter aortic valve implantation outcome with Evolut-R, Portico, and Acurate-NEO","volume":"97","author":"Gorla","year":"2021","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"964","DOI":"10.1016\/j.jcmg.2016.02.030","article-title":"Aortic Angulation Attenuates Procedural Success Following Self-Expandable But Not Balloon-Expandable TAVR","volume":"9","author":"Abramowitz","year":"2016","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_17","first-page":"630","article-title":"Difficulties with horizontal aortic root in transcatheter aortic valve implantation","volume":"81","author":"Chan","year":"2013","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"e736","DOI":"10.4244\/EIJV15I9A136","article-title":"TAVI and horizontal aorta: A \u201cno impact\u201d relationship?","volume":"15","author":"Kitamura","year":"2019","journal-title":"EuroIntervention"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1245","DOI":"10.1161\/CIRCULATIONAHA.112.092544","article-title":"Cerebral embolization during transcatheter aortic valve implantation: A transcranial Doppler study","volume":"126","author":"Kahlert","year":"2012","journal-title":"Circulation"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"2403","DOI":"10.1056\/NEJMoa2415120","article-title":"Routine Cerebral Embolic Protection during Transcatheter Aortic-Valve Implantation","volume":"392","author":"Kharbanda","year":"2025","journal-title":"N. Engl. J. Med."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1290","DOI":"10.1016\/j.jcin.2011.08.012","article-title":"A high-risk period for cerebrovascular events exists after transcatheter aortic valve implantation","volume":"4","author":"Tay","year":"2011","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"718","DOI":"10.1016\/j.jcin.2015.01.020","article-title":"Incidence and predictors of debris embolizing to the brain during transcatheter aortic valve implantation","volume":"8","author":"Rahhab","year":"2015","journal-title":"JACC Cardiovasc. Interv."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"2143","DOI":"10.1016\/j.jacc.2011.08.024","article-title":"Stroke associated with surgical and transcatheter treatment of aortic stenosis: A comprehensive review","volume":"58","author":"Daneault","year":"2011","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_24","first-page":"1897","article-title":"Stroke after transcatheter aortic valve replacement: A severe complication with low predictability","volume":"99","author":"Eschenbach","year":"2022","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"2306","DOI":"10.1001\/jama.2019.7525","article-title":"Association Between Transcatheter Aortic Valve Replacement and Early Postprocedural Stroke","volume":"321","author":"Huded","year":"2019","journal-title":"JAMA"},{"key":"ref_26","first-page":"E536","article-title":"Association between surgical risk and 30-day stroke after transcatheter versus surgical aortic valve replacement: A systematic review and meta-analysis","volume":"97","author":"Matsuda","year":"2021","journal-title":"Catheter. Cardiovasc. Interv."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"9593","DOI":"10.1038\/s41598-021-89217-0","article-title":"Late stroke after transcatheter aortic valve replacement: A nationwide study","volume":"11","author":"Bjursten","year":"2021","journal-title":"Sci. Rep."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1161\/CIRCRESAHA.111.246876","article-title":"The intersection between aging and cardiovascular disease","volume":"110","author":"North","year":"2012","journal-title":"Circ. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"2579","DOI":"10.1016\/j.jacc.2020.09.605","article-title":"Brain Injury After Transcatheter Replacement of Bicuspid Versus Tricuspid Aortic Valves","volume":"76","author":"Fan","year":"2020","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"567","DOI":"10.1161\/01.STR.0000155727.82242.e1","article-title":"The pathophysiology of watershed infarction in internal carotid artery disease: Review of cerebral perfusion studies","volume":"36","author":"Baron","year":"2005","journal-title":"Stroke"},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"2229","DOI":"10.1161\/CIRCULATIONAHA.120.052874","article-title":"Cerebral Embolic Protection and Outcomes of Transcatheter Aortic Valve Replacement: Results From the Transcatheter Valve Therapy Registry","volume":"143","author":"Butala","year":"2021","journal-title":"Circulation"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1016\/j.jacasi.2025.01.017","article-title":"A New Benchmark for Modern Management of Valvular Heart Disease: The Whole-Life Cycle Management System","volume":"5","author":"Wang","year":"2025","journal-title":"JACC Asia"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6715\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T04:31:22Z","timestamp":1788323482000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/15\/17\/6715"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,8,29]]},"references-count":32,"journal-issue":{"issue":"17","published-online":{"date-parts":[[2026,9]]}},"alternative-id":["jcm15176715"],"URL":"https:\/\/doi.org\/10.3390\/jcm15176715","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,8,29]]}}}