Key result
In patients undergoing transfemoral TAVI, significant LVOT calcification was associated with a higher 30-day rate of all-cause mortality and stroke compared to no significant calcification (10.1% vs 4.6%, p=0.008).
Why the study?
LVOT calcification was known to be associated with adverse outcomes after TAVI with first-generation devices, but its prevalence and impact in a contemporary cohort remained to be assessed.
Does significant LVOT calcification worsen clinical outcomes in patients undergoing transfemoral TAVI with current-generation devices?
Cohort (n=1,207)
No
Does significant LVOT calcification worsen clinical outcomes in patients undergoing transfemoral TAVI with current-generation devices?
Absolute Event Rate: 10.1% vs 4.6%
p-value: p=0.008
Significant LVOT calcification is common in TAVI patients and is associated with worse short-term functional outcomes and higher one-year mortality, highlighting the need for careful anatomical risk stratification.
May warrant LVOT calcification review in TAVI planning; leaves open whether mitigation alters outcomes in prospective trials.
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: , 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.
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A 2022 study conducted a cohort in Severe aortic stenosis (n=1,207). Significant LVOT calcification (>10 mm3) vs. No significant LVOT calcification (≤10 mm3) was evaluated on Composite of all-cause mortality and non-disabling/disabling stroke at 30 days (p=0.008). In patients undergoing transfemoral TAVI, significant LVOT calcification was associated with a higher 30-day rate of all-cause mortality and stroke compared to no significant calcification (10.1% vs 4.6%, p=0.008).
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