Porcelain Aorta in TAVR: Predictor of Adverse Outcomes or Overestimated Risk Factor?

Area of Science:

• Cardiology
• Interventional Cardiology
• Vascular Surgery

Background:

• Porcelain aorta (PA) presents significant surgical challenges for aortic valve replacement (AVR).
• Transcatheter aortic valve replacement (TAVR) is an alternative for PA patients, but prognostic data are limited.
• Evaluating PA's impact on short-term outcomes after TAVR is crucial.

Purpose of the Study:

• To assess the association between porcelain aorta (PA) and adverse short-term outcomes following transcatheter aortic valve replacement (TAVR).
• To compare outcomes in TAVR patients with and without PA.

Main Methods:

• Retrospective analysis of 2037 consecutive, surgery-naïve TAVR patients (2012-2020).
• Patients categorized into porcelain aorta (PA) and non-calcific aorta (NC) groups based on CT scans.
• Inverse probability of treatment weighting (IPTW) and logistic regression used for covariate adjustment.

Main Results:

• 40 patients (2%) had PA; they were younger and had more heart failure and peripheral artery disease.
• No significant differences in post-TAVR mortality, stroke, or renal function between PA and NC groups.
• PA patients had significantly longer in-hospital and ICU lengths of stay.

Conclusions:

• Porcelain aorta (PA) is not associated with increased mortality, stroke, or renal failure risk after TAVR.
• PA is linked to prolonged postoperative hospital and ICU stays.
• TAVR is a safe and effective AVR option for patients with severe aortic calcification precluding traditional surgery.