Abstract
Abstract Background and aims: Aortic valve calcium has been correlated with postoperative complications such as paravalvular leak or conduction disturbances. We aimed to assess relationship between AVC and onset and degree of other major clinical complications following TAVI according to VARC-2 criteria. Methods: We retrospectively analyzed preoperative contrast-enhanced CT scans of patients who underwent TAVI in our center between 2012 and 2016. Calcium volume was calculated through a dedicate software. Multivariate analysis (including aortic calcium volume, clinical as echocardiographic characteristics and intraoperative outcomes) was performed to evaluate the risk factors for stroke, perioperative myocardial infarction, bleeding, vascular complication, acute kidney injury (AKIN). Results: 539 patients were eligible for the study. Four different prostheses models were routinely implanted (2 balloon-expandable, n = 398; 2 self-expandable, n = 141). Median calcium volume in the DLZ was 757 mm3 (IQR 734.2), with no significant differences among prosthesis. Following complications were observed: 30-days mortality 5.38%; AKIN stage1 = 5.01%; AKIN stage2 = 1.67%; AKIN stage3 = 4.45%; major vascular complications = 4.08%; minor vascular complications = 10.20%; life-threating bleeding = 2.60%; major bleeding = 11.32%; stroke = 1.48%; periprocedural myocardial infarct = 0.37%. In multivariate linear regression aortic calcification of non-coronary cusp has been found to be independent predictor of ischemic stroke (OR 1.002, 95%CI 1–1.0047, p = 0.022) and AKIN stage 1 (OR1.002, 95%CI 1.001–1.004, p = 0.008), while LVOT total calcium volume was an independent predictor of AKIN stage 2 (OR 1.004, 95%CI 1–1.007, p = 0.043). Univariate analysis showed no significant correlation of aortic calcification with perioperative myocardial infarction, bleeding and vascular complication. Conclusions: AVC is an independent predictor of post-interventional ischemic stroke and acute kidney injury following TAVI.
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