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

Asami, Masahiko; Bernhard, Benedikt; Demirel, Caglayan; Okuno, Taishi; Stortecky, Stefan; Heg, Dik; Tomii, Daijiro; Reineke, David; Praz, Fabien; Lanz, Jonas; Windecker, Stephan; Gräni, Christoph; Pilgrim, Thomas (2021). Clinical outcomes following transcatheter aortic valve implantation in patients with porcelain aorta. Journal of cardiovascular computed tomography, 16(3), pp. 215-221. Elsevier 10.1016/j.jcct.2021.10.006

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BACKGROUND

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.

METHODS

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.

RESULTS

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).

CONCLUSIONS

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.

Item Type:

Journal Article (Original Article)

Division/Institute:

04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiology
04 Faculty of Medicine > Department of Cardiovascular Disorders (DHGE) > Clinic of Cardiovascular Surgery
04 Faculty of Medicine > Pre-clinic Human Medicine > CTU Bern

UniBE Contributor:

Asami, Masahiko; Bernhard, Benedikt; Demirel, Caglayan; Okuno, Taishi; Stortecky, Stefan; Heg, Dierik Hans; Reineke, David Christian; Praz, Fabien Daniel; Lanz, Jonas; Windecker, Stephan; Gräni, Christoph and Pilgrim, Thomas

Subjects:

600 Technology > 610 Medicine & health

ISSN:

1876-861X

Publisher:

Elsevier

Language:

English

Submitter:

Andrea Flükiger-Flückiger

Date Deposited:

16 Nov 2021 18:38

Last Modified:

27 Apr 2022 11:51

Publisher DOI:

10.1016/j.jcct.2021.10.006

PubMed ID:

34756819

Uncontrolled Keywords:

Aortic stenosis Clinical outcomes Computed tomography Porcelain aorta Transcatheter aortic valve implantation

BORIS DOI:

10.48350/161180

URI:

https://boris.unibe.ch/id/eprint/161180

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