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Aortic Calcium Score and TAVR: Insights into Procedural Complications and Device Selection
Session:
SESSÃO DE POSTERS 39 - IMAGEM CARDÍACA NA ESTENOSE AÓRTICA
Speaker:
Ana Rita Andrade
Congress:
CPC 2025
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.2 Computed Tomography
Session Type:
Cartazes
FP Number:
---
Authors:
Ana Rita Andrade; Miguel Azaredo Raposo; Catarina Oliveira; Ana Abrantes; Catarina Gregório; João Fonseca; Daniel Cazeiro; Miguel Nobre Menezes; Cláudia Jorge; João Silva Marques; Pedro Carrilho Ferreira; Fausto J. Pinto
Abstract
<p style="text-align:justify"><strong>Introduction</strong>: The aortic calcium score (aCS) is a non-invasive diagnostic tool that offers crucial insights into the severity of aortic stenosis (AS). However, it is still underused in the transcatheter aortic valve replacement (TAVR) risk stratification and procedural planning.</p> <p style="text-align:justify"><strong>Objectives</strong>: To evaluate the association of aCS to TAVR procedural complications and pos-procedural outcomes. </p> <p style="text-align:justify"><strong>Methods</strong>: Single-center prospective study of consecutive patients (pts) submitted to TAVR that had aCS measured on a pre-procedure computed tomography (CT). Demographic, echocardiography and procedural data were collected at baseline. Echocardiographic evaluation was performed the day after the procedure and at one year follow-up. Descriptive and comparative statistical analyses were employed.</p> <p style="text-align:justify"><strong>Results</strong>: We included 187 pts, 54.5% female, with a median age of 83 years old. Hypertension (89.9%), dyslipidemia (75.4%), diabetes (35.8%) and chronic kidney disease (28.9%) were the main co-morbidities. The median aCS was 1235 Agatston Units (AU). Mild to moderate aortic leak was present in final procedure aortography in 48.5% of pts, while it was classified as trace to mild in 70% and moderate in 3.7% by echocardiography. </p> <p style="text-align:justify">There was an association between higher aCS and the need for TAVR post-dilation (p=0.001) and higher degrees of aortic leak assessed in final aortography (p=0.004). An aCS cutoff of 5213AU demonstrated substantial sensitivity and specificity in predicting immediate post-deployment aortic leaks (sensitivity 71%; specificity 86%; AUC 0.811 - <strong>Figure 1</strong>).</p> <p style="text-align:justify">There was also an association between aCS and more than mild prosthetic leak (p=0.005) at echocardiographic assessment at day 1 after TAVR, as well as higher maximum and mean transaortic gradients (p=0.005 and p<0.001, respectively). </p> <p style="text-align:justify">Regarding the aortic prosthetic implanted, supra-annular aortic valves were associated with more significant leaks both by aortography (p<0.001) and echocardiographic (p=0.083) assessment. At echocardiogram, the decrease in maximum and mean transaortic gradients was higher when supra-annular TAVR devices were used (p=0.010 and p=0.017, respectively). The use of supra-annular devices was an independently predictor of leak (p=0.002). </p> <p style="text-align:justify"><strong>Conclusion</strong>: Our study showed that higher aCS correlated with the need for TAVR device post-dilation and the occurrence of peri-device leaks. Our findings suggest that, in patients with high aCS, supra-annular devices result in higher prevalence of leak that is not prevented by higher use of post-dilatation. </p>
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