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Predictors of clinical outcome in transfemoral TAVI: Circumferential iliofemoral calcifications and manufacturer-derived recommendations [Anatol J Cardiol]
Anatol J Cardiol. 2015; 15(4): 297-305 | DOI: 10.5152/akd.2014.5311  

Predictors of clinical outcome in transfemoral TAVI: Circumferential iliofemoral calcifications and manufacturer-derived recommendations

Markus Reinthaler1, Sunil K. Aggarwal1, Rodney De Palma1, Ulf Landmesser2, Georg Froehlich1, John Yap3, Pascal Meier1, Michael J. Mullen1
1Department of Cardiology, The Heart Hospital University College London Hospitals, London-England
2Department of Cardiology, University Hospital, Zürich-Switzerland
3Department of Cardiac Surgery, The Heart Hospital University College London Hospitals, London-England

Objective: This study aimed to investigate the predictive value of circumferential iliofemoral calcifications and current manufacturer recommendations, 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 multislice 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 vascular 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, circumferential 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 calcifications may provide independent prognostic information in patients undergoing TAVI. 
 

Keywords: circumferential iliofemoral calcifications, manufacturer recommendations, TAVI


Transfemoral TAVİ’de, klinik sonuçların belirleyicileri: Sirkumferansiyel iliyo-femoral kalsifikasyonlar ve yapımcının önerileri

Markus Reinthaler1, Sunil K. Aggarwal1, Rodney De Palma1, Ulf Landmesser2, Georg Froehlich1, John Yap3, Pascal Meier1, Michael J. Mullen1
1Department of Cardiology, The Heart Hospital University College London Hospitals, London-England
2Department of Cardiology, University Hospital, Zürich-Switzerland
3Department of Cardiac Surgery, The Heart Hospital University College London Hospitals, London-England

Amaç: Bu çalışma, transfemoral (TF) TAVİ’de, kanıta dayalı önerilerini değil; hali hazırda sirkumferansiyel ilio-femoral kalsifikasyonların öngörü değerini araştırmayı amaçlamıştır.

 
Yöntemler: TF TAVI’ye gidecek (n=132) ilio-femoral anatomide, geniş bir yelpazedeki bir hasta toplumu, mevcut önerilere göre retrospektif olarak "uygun" (n=76, %58) ve "uygun değil" (n=56, %42) adaylara ayrıldı. Hastaların çoğunda kabul taraması için ilio-femoral anjiyografi ve rekonstrükte multislays CT (MSCT) görüntüleri kullanıldı.

 
Bulgular: "Uygunsuz” olan grupta, damar özellikleri belirgin olarak kötüydü. “Uygunsuz” olan grupta, kılıfın minimal iç damar çapına oranı (MİDÇ) ve kalsiyum skoru 1,35±0,2 ve 1,7±0,8’di. Bu "uygun" grup hastalardakilerle 1,0±0,12 (p <0.0001) ve 1,0±0,7 (p=0,0001) karşılaştırıldı. Majör vasküler komplikasyonları (MVK), "uygunsuz" grupta (%10,7'ye karşı %2,6, p=0,07) daha sık meydana geldi ve dairesel iliyo-femoral kireçlenmeler [OR: 6, CI (%95): =0,025 1,2-26, p], MİDÇ tarafından öngörülebildi [OR 64, CI (%95): 1,4-2971, p=0,03]. Çok değişkenli analizde, sirkumferansiyel kalsifikasyonlara karşılık [HR: 3,6, CI: 1-13,2 (CI %95), p=0,043], majör vasküler komplikasyon ya da üreticinin önerileri, artan mortalite ile ilgili bulunmamıştır.

 
Sonuç: Sonuçlarımıza göre, yapımcı önerileri güvenli fakat fazla korumacıdır. Sirkumferansiyel ilio-femoral kalsifikasyonlar, TAVİ’ye giden hastada, bağımsız bir prognostik bilgi sağlayabilir.

Anahtar Kelimeler: dairesel ilio-femoral kalsifikasyonlar, üretici önerileri, TAVİ


Markus Reinthaler, Sunil K. Aggarwal, Rodney De Palma, Ulf Landmesser, Georg Froehlich, John Yap, Pascal Meier, Michael J. Mullen. Predictors of clinical outcome in transfemoral TAVI: Circumferential iliofemoral calcifications and manufacturer-derived recommendations. Anatol J Cardiol. 2015; 15(4): 297-305


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