Association of aortic valvular complex calcification burden with procedural and long-term clinical outcomes after transcatheter aortic valve replacement.

Abstract

AIMS:

This study aimed to assess the impact of valvular/subvalvular calcium burden on procedural and long-term outcomes in patients undergoing transcatheter aortic valve replacement (TAVR) for severe aortic stenosis (AS).

METHODS AND RESULTS:

In this prospective observational cohort study, we included patients with AS undergoing TAVR between March 2010 and December 2019. Calcium burden at baseline was quantified using multidetector computed tomography and the patients were classified into tertile groups according to the amount of calcium. Procedural outcomes [paravalvular leakage (PVL) or permanent pacemaker insertion (PPI)] and 12-month clinical outcomes (composite of death, stroke, or rehospitalization, and all-cause mortality) were assessed. A total of 676 patients (age, 79.8 ± 5.4 years) were analysed. The 30-day rates of moderate or severe PVL (P-for-trend = 0.03) and PPI (P-for-trend = 0.002) proportionally increased with the tertile levels of calcium volume. The 12-month rate of primary composite outcomes was 34.2% in low-tertile, 23.9% in middle-tertile, and 25.8% in high-tertile groups (log-rank P = 0.02). After multivariable adjustment, the risk for primary composite outcomes at 12 months was not significantly different between the tertile groups of calcium volume [reference = low-tertile; middle-tertile, hazard ratio (HR) 0.81; 95% confidence interval (CI) 0.54-1.22; P = 0.31; high-tertile, HR 0.93; 95% CI 0.56-1.57; P = 0.80]. A similar pattern was observed for all-cause mortality.

CONCLUSION:

The rates of PVL and PPI proportionally increased according to the levels of valvular/subvalvular calcium volume, while the adjusted risks for composite outcomes and mortality at 12 months were not significantly different.

• Authors: Euihong Ko, Do-Yoon Kang, Jung-Min Ahn, Tae Oh Kim, Ju Hyeon Kim, Junghoon Lee, Seung-Ah Lee, Dae-Hee Kim, Ho Jin Kim, Joon Bum Kim, Suk Jung Choo, Seung-Jung Park, Duk-Woo Park
• Journal: European heart journal. Cardiovascular Imaging (Eur Heart J Cardiovasc Imaging) Vol. 23 Issue 11 Pg. 1502-1510 (10 20 2022) ISSN: 2047-2412 [Electronic] England
• PMID: 34491331 (Publication Type: Observational Study, Journal Article)
• Copyright: Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2021. For permissions, please email: [email protected].

Chemical References

• Calcium

Topics

• Humans
• Aged
• Aged, 80 and over
• Transcatheter Aortic Valve Replacement (adverse effects)
• Prospective Studies
• Calcium
• Risk Factors
• Treatment Outcome
• Aortic Valve Stenosis (diagnostic imaging, surgery, etiology)
• Aortic Valve (diagnostic imaging, surgery)
• Heart Valve Prosthesis