Impact of porcelain aorta on outcomes in transfemoral aortic valve implantation (TAVI) with balloon-expandable valves
Background Current guidelines recommend transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis and porcelain aorta (PA). Neurological outcomes of patients with PA undergoing TAVI with modern valves require clarification as most trials examined balloon-expandable valves (BEV...
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BMJ Publishing Group
2025-01-01
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| Series: | Open Heart |
| Online Access: | https://openheart.bmj.com/content/12/1/e003069.full |
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| author | Bernhard Schieffer Thomas Kuntze Tamer Owais Philipp Lauten Julian Kreutz Lisa C Costello-Boerrigter Mathias Schreiber Guido Boerrigter Christian Albert Mohammad El Garhy Björn Göbel Harald Lapp Birgit Markus |
| author_facet | Bernhard Schieffer Thomas Kuntze Tamer Owais Philipp Lauten Julian Kreutz Lisa C Costello-Boerrigter Mathias Schreiber Guido Boerrigter Christian Albert Mohammad El Garhy Björn Göbel Harald Lapp Birgit Markus |
| author_sort | Bernhard Schieffer |
| collection | DOAJ |
| description | Background Current guidelines recommend transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis and porcelain aorta (PA). Neurological outcomes of patients with PA undergoing TAVI with modern valves require clarification as most trials examined balloon-expandable valves (BEV) and self-expandable valves in intermediate or high-risk patients, but not specifically in patients with PA. Our aim was to compare outcomes, including stroke and mortality, in well-matched patients with and without PA who received BEV during transfemoral TAVI procedures.Methods Consecutive patients undergoing TAVI were entered into a registry. For this single-centre (Zentralklinik Bad Berka, Germany), retrospective analysis, we only selected patients who received BEV. PA diagnosis was made when non-contrast axial CT images fulfilled Valve Academic Research Consortium-2 criteria for PA. There was 2:1 nearest neighbour matching of patients without and with PA. The primary outcome measure was 30-day mortality or stroke within 72 hours. Secondary outcome measures were 30-day mortality, stroke within 72 hours, technical success and 30-day device success.Results After matching patients with (n=141) and without PA (n=282), the primary outcome of mortality at <30 days or stroke within 72 hours was higher in PA versus non-PA (7.8% vs 2.5%; OR 3.32 (95% CI 1.25 to 8.85); p=0.019). With regard to secondary outcomes, PA was not associated with mortality at 30 days (4.3% vs 2.1%; OR 2.04 (95% CI 0.65 to 6.48); p=0.23); however, stroke within 72 hours was significantly higher in PA versus non-PA (3.5% vs 0.4%; OR 10.33 (95% CI 1.17 to 91.12); p=0.017). Technical and device success were uninfluenced by PA.Conclusions Transfemoral TAVI with BEV in patients with PA was associated with a higher risk of the primary combined endpoint of mortality at 30 days or stroke within 72 hours, which was primarily driven by stroke within 72 hours. These findings might influence cerebral embolic protection device use in patients with PA. |
| format | Article |
| id | doaj-art-913b6b585aa84dcea4f42eea59889dda |
| institution | Kabale University |
| issn | 2053-3624 |
| language | English |
| publishDate | 2025-01-01 |
| publisher | BMJ Publishing Group |
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| series | Open Heart |
| spelling | doaj-art-913b6b585aa84dcea4f42eea59889dda2025-01-31T22:30:10ZengBMJ Publishing GroupOpen Heart2053-36242025-01-0112110.1136/openhrt-2024-003069Impact of porcelain aorta on outcomes in transfemoral aortic valve implantation (TAVI) with balloon-expandable valvesBernhard Schieffer0Thomas Kuntze1Tamer Owais2Philipp Lauten3Julian Kreutz4Lisa C Costello-Boerrigter5Mathias Schreiber6Guido Boerrigter7Christian Albert8Mohammad El Garhy9Björn Göbel10Harald Lapp11Birgit Markus12Department of Cardiology, Angiology, and Intensive Care Medicine, University Hospital of Giessen and Marburg, Marburg, GermanyDepartment of Cardiac Surgery, Central Hospital Bad Berka, Bad Berka, GermanyCardiac Surgery, Zentralklinik Bad Berka, Augsburg, GermanyHeart Center/Structural Heart, Zentralklinik Bad Berka, Bad Berka, GermanyPhilipps University of Marburg, Marburg, GermanyClinical Research Rhön-Klinikum, Bad Neustadt, GermanyDepartment of Cardiology and Intensive Care Medicine, Zentralklinik Bad Berka, Bad Berka, GermanyDepartment of Cardiology and Intensive Care Medicine, Zentralklinik Bad Berka, Bad Berka, GermanyDepartment of Nephrology, Zentralklinik Bad Berka, Bad Berka, GermanyDepartment of Cardiology, Klinikum Hersfeld-Rotenburg, Bad Hersfeld, GermanyDepartment of Cardiology and Intensive Care Medicine, Zentralklinik Bad Berka, Bad Berka, GermanyPhilipps University of Marburg, Marburg, GermanyPhilipps University of Marburg, Marburg, GermanyBackground Current guidelines recommend transcatheter aortic valve implantation (TAVI) for patients with aortic stenosis and porcelain aorta (PA). Neurological outcomes of patients with PA undergoing TAVI with modern valves require clarification as most trials examined balloon-expandable valves (BEV) and self-expandable valves in intermediate or high-risk patients, but not specifically in patients with PA. Our aim was to compare outcomes, including stroke and mortality, in well-matched patients with and without PA who received BEV during transfemoral TAVI procedures.Methods Consecutive patients undergoing TAVI were entered into a registry. For this single-centre (Zentralklinik Bad Berka, Germany), retrospective analysis, we only selected patients who received BEV. PA diagnosis was made when non-contrast axial CT images fulfilled Valve Academic Research Consortium-2 criteria for PA. There was 2:1 nearest neighbour matching of patients without and with PA. The primary outcome measure was 30-day mortality or stroke within 72 hours. Secondary outcome measures were 30-day mortality, stroke within 72 hours, technical success and 30-day device success.Results After matching patients with (n=141) and without PA (n=282), the primary outcome of mortality at <30 days or stroke within 72 hours was higher in PA versus non-PA (7.8% vs 2.5%; OR 3.32 (95% CI 1.25 to 8.85); p=0.019). With regard to secondary outcomes, PA was not associated with mortality at 30 days (4.3% vs 2.1%; OR 2.04 (95% CI 0.65 to 6.48); p=0.23); however, stroke within 72 hours was significantly higher in PA versus non-PA (3.5% vs 0.4%; OR 10.33 (95% CI 1.17 to 91.12); p=0.017). Technical and device success were uninfluenced by PA.Conclusions Transfemoral TAVI with BEV in patients with PA was associated with a higher risk of the primary combined endpoint of mortality at 30 days or stroke within 72 hours, which was primarily driven by stroke within 72 hours. These findings might influence cerebral embolic protection device use in patients with PA.https://openheart.bmj.com/content/12/1/e003069.full |
| spellingShingle | Bernhard Schieffer Thomas Kuntze Tamer Owais Philipp Lauten Julian Kreutz Lisa C Costello-Boerrigter Mathias Schreiber Guido Boerrigter Christian Albert Mohammad El Garhy Björn Göbel Harald Lapp Birgit Markus Impact of porcelain aorta on outcomes in transfemoral aortic valve implantation (TAVI) with balloon-expandable valves Open Heart |
| title | Impact of porcelain aorta on outcomes in transfemoral aortic valve implantation (TAVI) with balloon-expandable valves |
| title_full | Impact of porcelain aorta on outcomes in transfemoral aortic valve implantation (TAVI) with balloon-expandable valves |
| title_fullStr | Impact of porcelain aorta on outcomes in transfemoral aortic valve implantation (TAVI) with balloon-expandable valves |
| title_full_unstemmed | Impact of porcelain aorta on outcomes in transfemoral aortic valve implantation (TAVI) with balloon-expandable valves |
| title_short | Impact of porcelain aorta on outcomes in transfemoral aortic valve implantation (TAVI) with balloon-expandable valves |
| title_sort | impact of porcelain aorta on outcomes in transfemoral aortic valve implantation tavi with balloon expandable valves |
| url | https://openheart.bmj.com/content/12/1/e003069.full |
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