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

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.