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Impact of moderate or severe left ventricular outflow tract calcification on clinical outcomes of patients with severe aortic stenosis undergoing transcatheter aortic valve implantation with self- and balloon-expandable valves: a post hoc analysis from the SOLVE-TAVI trial

Background: Left ventricular outflow tract (LVOT) calcification has been associated with worse outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and may influence the selection of prosthetic valve type. Aims: We aimed to evaluate the impact of LVOT calcification on outco...

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Main Authors: Farhan, Serdar (Author) , Stachel, Georg (Author) , Desch, Steffen (Author) , Kurz, Thomas (Author) , Feistritzer, Hans-Josef (Author) , Hartung, Philipp (Author) , Eitel, Ingo (Author) , Nef, Holger (Author) , Doerr, Oliver (Author) , Lauten, Alexander (Author) , Landmesser, Ulf (Author) , Sandri, Marcus (Author) , Holzhey, David (Author) , Borger, Michael (Author) , Ince, Hüseyin (Author) , Öner, Alper (Author) , Meyer-Saraei, Roza (Author) , Wienbergen, Harm (Author) , Fach, Andreas (Author) , Frey, Norbert (Author) , De Waha-Thiele, Suzanne (Author) , Thiele, Holger (Author)
Format: Article (Journal)
Language:English
Published: 2022
In: EuroIntervention
Year: 2022, Volume: 18, Issue: 9, Pages: 759-768
ISSN:1969-6213
DOI:10.4244/EIJ-D-22-00156
Online Access:Verlag, lizenzpflichtig, Volltext: https://dx.doi.org/10.4244/EIJ-D-22-00156
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Author Notes:Serdar Farhan, Georg Stachel, Steffen Desch, Thomas Kurz, Hans-Josef Feistritzer, Philipp Hartung, Ingo Eitel, Holger Nef, Oliver Doerr, Alexander Lauten, Ulf Landmesser, Marcus Sandri, David Holzhey, Michael Borger, Hüseyin Ince, Alper Öner, Roza Meyer-Saraei, Harm Wienbergen, Andreas Fach, Norbert Frey, Suzanne de Waha-Thiele, Holger Thiele
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Summary:Background: Left ventricular outflow tract (LVOT) calcification has been associated with worse outcomes in patients undergoing transcatheter aortic valve implantation (TAVI) and may influence the selection of prosthetic valve type. Aims: We aimed to evaluate the impact of LVOT calcification on outcomes after TAVI with a self-expanding valve (SEV) versus a balloon-expandable valve (BEV). Methods: Patients of the SOLVE-TAVI trial, randomised to Edwards SAPIEN 3 or Medtronic Evolut R, were divided according to LVOT calcification into no/mild (≤1 calcium nodule extending <5 mm and covering <10% of the LVOT perimeter) and moderate/severe LVOT calcification groups. The primary endpoint was a composite of death, stroke, moderate/severe paravalvular regurgitation, permanent pacemaker implantation and annulus rupture at 30 days. Additional endpoints included all-cause and cardiovascular mortality at 1 year. Results: Out of 416 eligible patients, moderate/severe LVOT calcification was present in 143 (34.4%). Moderate/severe LVOT calcification was associated with significantly longer fluoroscopy time and higher rates of pre- and post-dilation. Regardless of the LVOT calcification group, there was no significant difference in the primary endpoint associated with the valve type (no/mild LVOT calcification group: SEV 25.0% vs BEV 27.0%; hazard ratio [HR] 1.10, 95% confidence interval [95% CI]: 0.68-1.73; p=0.73 and moderate/severe LVOT calcification group: SEV 25.0% vs BEV 19.4%; HR 0.76, 95% CI: 0.38-1.61; p=0.49), no significant interaction between LVOT calcification and valve type (pint=0.29) and no differences between SEV vs BEV within LVOT calcification groups regarding 1-year all-cause and cardiovascular mortality. Conclusions: Moderate/severe LVOT calcification was associated with longer fluoroscopy time and an increased need for pre- and post-dilation, but not with a higher incidence of early and mid-term adverse clinical outcomes, regardless of valve type. (ClinicalTrials.gov: NCT02737150)
Item Description:Gesehen am 26.04.2023
Physical Description:Online Resource
ISSN:1969-6213
DOI:10.4244/EIJ-D-22-00156

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