Clinical outcomes following transcatheter aortic valve implantation in patients with porcelain aorta.

Journal of cardiovascular computed tomography 2022 May-Jun

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Current guidelines favor transcatheter aortic valve implantation (TAVI) over surgical aortic valve replacement in patients with porcelain aorta (PAo). The clinical relevance of PAo in patients undergoing TAVI is however incompletely understood. The purpose of this study is to evaluate clinical outcome of patients with PAo undergoing TAVI. Consecutive patients undergoing TAVI were enrolled in a prospective single-center registry. Presence of PAo was evaluated by ECG-gated multi-slice computed tomography prior to the intervention. The primary endpoint was disabling stroke. Among 2199 patients (mean age, 82.0 ± 6.3 years; 1135 females [51.6%]) undergoing TAVI between August 2007 and December 2019, 114 patients (5.2%) met VARC-2 criteria for PAo. Compared to individuals without PAo, patients with PAo were younger (79.4 ± 7.4 years vs. 82.1 ± 6.2 years; p < 0.001), had a lower left ventricular ejection fraction (51.8 ± 14.9% vs. 55.3 ± 14.2%; p = 0.009) and higher STS-PROM Scores (6.5 ± 4.3% vs. 4.9 ± 3.4%; p < 0.001). At 1 year, disabling stroke occurred more often in patients with PAo (7.2%) than in those without (3.0%) (HRadj, 2.49; 95% CI, 1.12-5.55). The risk difference emerged within 30 days after TAVI (HRadj, 3.70; 95% CI, 1.52-9.03), and was driven by a high PAo-associated risk of disabling stroke in patients with alternative access (HRadj, 5.79; 95% CI, 1.38-24.3), not in those with transfemoral (HRadj, 1.47; 95% CI 0.45-4.85). TAVI patients with PAo had a more than three-fold increased risk of periprocedural disabling stroke compared to patients with no PAo. The difference was driven by a higher risk of stroke in patients treated by alternative access. Copyright © 2021 The Authors. Published by Elsevier Inc. All rights reserved.

Citation

Masahiko Asami, Benedikt Bernhard, Caglayan Demirel, Taishi Okuno, Stefan Stortecky, Dik Heg, Daijiro Tomii, David Reineke, Fabien Praz, Jonas Lanz, Stephan Windecker, Christoph Gräni, Thomas Pilgrim. Clinical outcomes following transcatheter aortic valve implantation in patients with porcelain aorta. Journal of cardiovascular computed tomography. 2022 May-Jun;16(3):215-221