Relation Between Left Ventricular Outflow Tract Calcium and Mortality Following Transcatheter Aortic Valve Implantation

Yoshio Maeno, Yigal Abramowitz, Sung Han Yoon, Sharjeel Israr, Hasan Jilaihawi, Yusuke Watanabe, Rahul Sharma, Hiroyuki Kawamori, Masaki Miyasaka, Yoshio Kazuno, Nobuyuki Takahashi, Babak Hariri, Geeteshwar Mangat, Mohammad Kashif, Tarun Chakravarty, Mamoo Nakamura, Wen Cheng, Raj R. Makkar

Research output: Contribution to journalArticlepeer-review

20 Scopus citations

Abstract

Left ventricular outflow tract (LVOT) calcium is known to be associated with adverse procedural outcomes after transcatheter aortic valve implantation (TAVI), yet its effect on midterm outcomes has not been previously investigated. The aim of this study was to determine the influence of LVOT calcium on 2-year mortality after TAVI. A total of 537 consecutive patients underwent TAVI and 2 groups were established, stratified based on the severity of the LVOT calcium. The primary outcome was 2-year overall survival rate. The ≥moderate LVOT calcium group included 107 patients (19.9%) and the remaining 430 patients (80.1%) were included in the ≤mild LVOT calcium group. After a median follow-up of 717 days (interquartile range 484 to 828), the Kaplan-Meier analysis revealed that the 2-year overall survival probability was significantly lower in the ≥moderate LVOT calcium group than in the ≤mild LVOT calcium group (log-rank p = 0.001). On a Cox hazard model, ≥moderate LVOT calcium was associated with increased all-cause mortality after TAVI (hazard ratio 1.74, p = 0.009). In the subgroup analysis, based on valve designs, SAPIEN 3-TAVI done in the setting of ≥moderate LVOT calcium had a relatively similar survival probability as those of ≤mild LVOT calcium (log-rank p = 0.18), which is in contrast with older generation valves (log-rank p = 0.001). In conclusion, patients with ≥moderate LVOT calcium were shown to have a lower survival probability in the midterm follow-up after TAVI, compared with those with ≤mild LVOT calcium. Patients with high-grade LVOT calcium should be monitored with longer-term follow-ups after TAVI.

Original languageEnglish
Pages (from-to)2017-2024
Number of pages8
JournalAmerican Journal of Cardiology
Volume120
Issue number11
DOIs
StatePublished - 1 Dec 2017
Externally publishedYes

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

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