"Incidental findings" during TAVI work-up: more than just an inconvenience

To characterise the clinical course of patients who had incidental findings on the CT aortogram (CTA) done as a transcatheter aortic valve implantation (TAVI) work-up investigation.

All patients who underwent CTA as a work-up investigation for TAVI were retrospectively recruited (n=295, 83±6.7 years) to identify those with an incidental finding. A total of 323 incidental findings were identified in 201 (68.1%) patients. Of those with incidental findings, 87 (43.3%) had at least one of immediate clinical significance. Within this group, fewer (52.9%) eventually had TAVI compared to those without incidental findings (63%). In patients going on to have TAVI, the time between CTA and TAVI was longer in those with incidental findings (median 96 vs. 81 days). At follow-up, overall mortality in those with incidental findings was higher than in those without (49.4% vs. 37.5%). In patients who underwent TAVI, there was a trend to increased mortality in those with incidental findings (34.8% vs. 21.4%, p=0.07).

Incidental findings were associated with a longer time to TAVI procedure, lower chance of eventually receiving TAVI as definitive therapy and a worse overall outcome. Such findings are clearly important and should be taken into account when delivering a contemporary TAVI service.