Markus Reinthaler, Sunil K. Aggarwal, Rodney De Palma, Ulf Landmesser 1, Georg Froehlich,Predictors of clinical outcome in transfemoral TAVI: Circumferential iliofemoral calcifications and manufacturer-derived recommendations

Abstract

Objective: This study aimed to investigate the predictive value of circumferential iliofemoral calcifications and current manufacturer recom- mendations, 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 mul- tislice 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±0.2 and 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 vas- cular 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, circumferen- tial 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 calcifica- tions may provide independent prognostic information in patients undergoing TAVI.