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Predictors of clinical outcome in transfemoral TAVI: Circumferential iliofemoral calcifications and manufacturer-derived recommendations

2014; KARE Publishing; Volume: 15; Issue: 4 Linguagem: Inglês

10.5152/akd.2014.5311

2149-2271

Markus Reinthaler, Sunil Aggarwal, Rodney De Palma, Ulf Landmesser, Georg M Froehlich, John Yap, Pascal Meier, Michael Mullen,

Cardiac Imaging and Diagnostics

Objective: This study aimed to investigate the predictive value of circumferential iliofemoral calcifications and current manufacturer recommendations, which are not evidence-based, in transfemoral (TF) transcatheter aortic valve implantation (TAVI) Methods: A patient cohort with a broad range of iliofemoral anatomies undergoing TF TAVI (n=132) were retrospectively divided as "suitable" (n=76, 58%) and "unsuitable" (n=56, 42%) candidates according to current recommendations.Iliofemoral angiography and reconstructed multislice CT (MSCT) images were used for access screening in the majority of patients.Results: Vessel properties were significantly worse in the "unsuitable group."The sheath-to-iliofemoral artery ratio (SIFAR) and calcium score were 1.35±0.2and 1.7±0.8 in the unsuitable group, compared to 1.0±0.12(p<0.0001) and 1.0±0.7 (p=0.0001) in the "suitable" patients.Major vascular complications (MVCs) occurred more frequently in the "unsuitable" group (10.7% vs. 2.6%, p=0.07) and were predicted by SIFAR [OR: 64, 95% CI: 1.4-2971, p=0.03] and circumferential iliofemoral calcifications [OR: 6, 95% CI: 1.2-26, p=0.025].In the multivariate analysis, circumferential calcifications [HR: 3.6, 95% CI: 1-13.2, p=0.043] but not major vascular complications (MVCs) or manufacturer recommendations were associated with increased mortality.Conclusion: According to our results, manufacturer recommendations are safe but overly conservative.Circumferential iliofemoral calcifications may provide independent prognostic information in patients undergoing TAVI.