Abstract 14226: Prognostic Impact of Hyperkyphosis in Patients Undergoing Transcatheter Aortic Valve Replacement

Abstract

Introduction: Hyperkyphosis, an excessive forward curvature of the upper spine seen in older people, can lead to pulmonary function decline, decreased physical performance, and frailty. However, there are no data on the prognostic impact of hyperkyphosis in transcatheter aortic valve replacement (TAVR). Hypothesis: Hyperkyphosis may be associated with poor clinical outcomes of TAVR. Methods: This study included 244 patients (age, 83.7 ± 5.4 years; 73.4% female) who underwent transfemoral TAVR at our institution between January 2016 and April 2020. Hyperkyphosis was defined as a Cobb angle of greater than 40°. Results: Hyperkyphosis was present in 47 patients (19.3%), and all had marked descending aortic tortuosity. Vascular and access-related complications were more frequent in the hyperkyphosis group (10.6% vs. 2.5%; P = 0.025). The event-free rate of clinical efficacy, which was a composite of death, stroke, and hospitalization for procedure- or valve-related causes, was lower in the hyperkyphosis group (Log-rank test, P = 0.001). Multivariate Cox regression analysis revealed that hyperkyphosis was an independent determinant of lower clinical efficacy (hazard ratio 2.24, 95% confidence interval 1.05-4.77; P = 0.037). Conclusions: Hyperkyphosis, present in approximately 20% of patients undergoing trans-femoral TAVR, is associated with more perioperative vascular complications and poor clinical outcomes.