Impact of left ventricular outflow tract calcification in patients undergoing transfemoral transcatheter aortic valve implantation

TY - JOUR

T1 - Impact of left ventricular outflow tract calcification in patients undergoing transfemoral transcatheter aortic valve implantation

AU - Waldschmidt, Lara

AU - Goßling, Alina

AU - Ludwig, Sebastian

AU - Linder, Matthias

AU - Voigtländer, Lisa

AU - Grundmann, David

AU - Bhadra, Oliver Daniel

AU - Demal, Till Joscha

AU - Schirmer, Johannes

AU - Reichenspurner, Hermann

AU - Blankenberg, Stefan

AU - Westermann, Dirk

AU - Seiffert, Moritz

AU - Conradi, Lenard

AU - Schofer, Niklas

PY - 2022/4/1

Y1 - 2022/4/1

N2 - BACKGROUND: Left ventricular outflow tract (LVOT) calcification is known to be associated with adverse outcomes after transcatheter aortic valve implantation (TAVI) in patients receiving first-generation transcatheter heart valves (THV).AIMS: The aim of the present study was to assess the prevalence of LVOT calcification as well as its impact on outcomes in a contemporary TAVI patient cohort.METHODS: This retrospective single-centre analysis includes 1,207 patients who underwent transfemoral TAVI between 2012 and 2018 and in whom adequate contrast-enhanced multislice computed tomgraphy (MSCT) imaging for quantification of LVOT calcification was available.RESULTS: Significant LVOT calcification, defined as >10 mm3, was present in 37.4% (n=451) of the patient cohort. After applying propensity score matching there was no difference between patients without (w/o; n=358) and with (w; n=358) significant LVOT calcification with respect to baseline clinical characteristics. At 30 days, the composite of all-cause mortality and non-disabling/disabling stroke occurred more often in patients w LVOT calcification compared to those w/o (4.6 vs 10.1%, p=0.008). Moreover, the composite VARC-3 endpoint of device success at 30 days was in favour of patients w/o LVOT calcification (82.2% vs 73.4%, p=0.007). According to Kaplan-Meier analysis, all-cause mortality one year after TAVI was higher in patients w vs w/o LVOT calcification (12.9 vs 21.4 %, p=0.004).CONCLUSIONS: In patients undergoing TAVI, the presence of significant LVOT calcification is common and associated with worse short-term clinical and functional outcomes as well as higher one-year mortality rates compared to patients w/o LVOT calcification.

AB - BACKGROUND: Left ventricular outflow tract (LVOT) calcification is known to be associated with adverse outcomes after transcatheter aortic valve implantation (TAVI) in patients receiving first-generation transcatheter heart valves (THV).AIMS: The aim of the present study was to assess the prevalence of LVOT calcification as well as its impact on outcomes in a contemporary TAVI patient cohort.METHODS: This retrospective single-centre analysis includes 1,207 patients who underwent transfemoral TAVI between 2012 and 2018 and in whom adequate contrast-enhanced multislice computed tomgraphy (MSCT) imaging for quantification of LVOT calcification was available.RESULTS: Significant LVOT calcification, defined as >10 mm3, was present in 37.4% (n=451) of the patient cohort. After applying propensity score matching there was no difference between patients without (w/o; n=358) and with (w; n=358) significant LVOT calcification with respect to baseline clinical characteristics. At 30 days, the composite of all-cause mortality and non-disabling/disabling stroke occurred more often in patients w LVOT calcification compared to those w/o (4.6 vs 10.1%, p=0.008). Moreover, the composite VARC-3 endpoint of device success at 30 days was in favour of patients w/o LVOT calcification (82.2% vs 73.4%, p=0.007). According to Kaplan-Meier analysis, all-cause mortality one year after TAVI was higher in patients w vs w/o LVOT calcification (12.9 vs 21.4 %, p=0.004).CONCLUSIONS: In patients undergoing TAVI, the presence of significant LVOT calcification is common and associated with worse short-term clinical and functional outcomes as well as higher one-year mortality rates compared to patients w/o LVOT calcification.

KW - Aortic Valve/diagnostic imaging

KW - Aortic Valve Stenosis

KW - Calcinosis/complications

KW - Heart Valve Prosthesis/adverse effects

KW - Humans

KW - Multidetector Computed Tomography

KW - Retrospective Studies

KW - Transcatheter Aortic Valve Replacement

KW - Treatment Outcome

U2 - 10.4244/EIJ-D-21-00464

DO - 10.4244/EIJ-D-21-00464

M3 - SCORING: Journal article

C2 - 34658340

VL - 17

SP - e1417-e1424

JO - EUROINTERVENTION

JF - EUROINTERVENTION

SN - 1774-024X

IS - 17

ER -