Findings beyond procedural region and their clinical implications in pre-transaortic valve replacement computed tomography in a second level hospital

Background Computed tomography (CT) is widely used for planification of transaortic valve replacement (TAVR) procedures. In coronary-CT scans concurrent findings are often reported. As TAVR population is generally older, these findings may be even more frequent. Methods We selected patients with CT preTAVR from February 2015 to March 2023 and reviewed findings other than aortic valve, heart failure, coronarial and/or vascular access disease. Findings were classified as cardiac, vascular and extracardiovascular. Anatomic variants were excluded. It was reported if findings were incidental, if more exams o treatment were needed, and if a cause for temporal o definite exclusion for TAVR. Results There were 145 patients (46% women) with mean age 82 (standard deviation (SD): 0,5). Among patients with no findings (14%), 25% women (mean age of 82 (range 78-87) and among patients with any finding, 49% were women (mean age 82 (SD: 0,5)) (χ2 p=0,04 for sex). 58% patients had 1 type of finding (1 patient cardiac, none patients vascular, the rest extracardiovascular). 26% with 2 type of findings, and 1 patient with 3 type of findings. 21% of patients had cardiac findings (mean 1.2 findings/patient, range 1-4): 2 patients (7%) incidental. 1 (3%) need for more treatment or exams with temporal exclusion for TAVR. 13% of patients had vascular findings (mean 1.4 findings/patient, range 1-3): 95% incidental, 3 patients (16%) needed more treatment and were temporally excluded from TAVR. 85% of patients had extracardiovascular findings (mean 5.8 findings/patient±3,2range 1-3): 80% incidental ones, 8% need more exams o treatment and 40% of them had temporal exclusion (1 patient died waiting for more exams). Definite exclusion was only due to extracardiovascular cause in 3 patients (2%). it is shown in picture 1 patients with incidental findings. Odds for treatment or exclusion vs no change was 0.03 in cardiac findings, 0.16 for vascular findings and 0,1 for extracardiovascular findings. It was more probable to have an actuation or exclusion if vascular or extracardiovascular incidental finding was prsente (OR: 5.3 for vascular, 33.3 for extracardiovascular) Conclusions Findings outside procedural region are very frequent, mainly known but sometimes incidental. Some of them may need treatment or exams and may cause temporal exclusion for TAVR but definite exclusion occurred rarely only with extracardiovascular ones. Male sex may be a factor for not having findings. Radiologists and clinicians should take this into account. cCT performed at second level hospital may avoid unnecessary referrals to TAVR centres.Graphic