Related Experiment Video
Updated: Dec 2, 2025
Improved Registration of 3D CT Angiography with X-ray Fluoroscopy for Image Fusion During Transcatheter Aortic Valve Implantation
Published on: June 3, 2018
Usefulness of Thoracic Aortic Calcium to Predict 1-Year Mortality After Transcatheter Aortic Valve Implantation
Mohanad Hamandi1, Pierre Amiens2, Paul A Grayburn1
1Cardiovascular Research, Baylor Scott and White-The Heart Hospital, Plano, Texas.
Insights
Thoracic aortic calcification (TAC) predicts mortality after transcatheter aortic valve implantation (TAVI). High TAC burden is linked to increased 1-year mortality, suggesting TAC can aid in patient risk assessment.
Area of Science:
- Cardiology
- Vascular Medicine
- Medical Imaging
Background:
- Vascular disease increases mortality risk in transcatheter aortic valve implantation (TAVI) patients.
- Thoracic aortic calcification (TAC) serves as an objective marker for vascular disease.
Purpose of the Study:
- To investigate the association between thoracic aortic calcification (TAC) burden and 1-year all-cause mortality in patients undergoing TAVI.
- To determine if TAC can serve as a predictor of mortality post-TAVI.
Main Methods:
- Retrospective review of 374 TAVI patients from July 2015 to July 2017.
- Categorization of TAC into low, moderate, and high burden using restricted cubic splines analysis.
- Evaluation of the association between TAC and survival using Cox regression models.
Main Results:
- Patients with high TAC burden (>2.9 cm³) had a 1-year all-cause mortality rate of 16%, versus 6% in low/moderate TAC groups (p=0.008).
- High TAC was significantly associated with increased mortality (HR 2.98) compared to low TAC.
- No significant difference in mortality was observed between moderate and low TAC groups.
Conclusions:
- Thoracic aortic calcification (TAC) is a significant predictor of late mortality following TAVI.
- Incorporating TAC measurement into preoperative assessments offers an objective tool for shared decision-making and risk stratification.
Abstract:
In patients who underwent transcatheter aortic valve implantation (TAVI), vascular disease is associated with increased risk of mortality. Thoracic aortic calcification (TAC), an objective surrogate of vascular disease, could be a predictor of mortality after TAVI. We aimed to analyze the association between TAC burden and 1-year all-cause mortality in patients who underwent TAVI in a US population. From July 2015 through July 2017, a retrospective review of TAVI procedures was performed at Baylor Scott & White-The Heart Hospital, Plano, Texas. Patients were analyzed for comorbidities, cardiac risk factors, and 30-day and 1-year all-cause mortality. Restricted cubic splines analysis was used to define low, moderate, and high TAC categories. The association between TAC and survival was evaluated using unadjusted and adjusted Cox models. A total of 431 TAVI procedures were performed, of which TAC was measured in 374 (81%) patients. Median (interquartile range) age was 82 (77, 87) years, and 51% were male. Median (interquartile range) STS PROM was 5.6 (4.1, 8.2) %. Overall 30-day and 1-year all-cause mortality was 1% and 10%, respectively. TAC was categorized as low (<1.6 cm3), moderate (1.6 to 2.9 cm3), and high (>2.9 cm3). At 1 year, all-cause mortality was 16% in patients with high TAC compared with 6% in the low and moderate TAC categories (p = 0.008). Unadjusted and adjusted Cox regression analysis showed a significant increase in mortality for patients with high TAC compared with low TAC (hazard ratio 2.98, 95% confidence interval [1.34-6.63]), but not significant compared with moderate TAC group. TAC is a predictor of late mortality after TAVI. In conclusion, adding TAC to preoperative evaluation may provide an objective, reproducible, and potentially widely available tool that can help in shared decision-making.
