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

Background and Objectives: Patients with porcelain aorta (PA) pose major surgical challenges during aortic valve replacement, making transcatheter aortic valve replacement (TAVR) the preferred alternative. However, data on the prognostic significance of PA among TAVR recipients are limited. This study sought to evaluate whether PA is associated with adverse short-term outcomes following TAVR. Materials and Methods: Consecutive, surgery-naïve patients who underwent TAVR between 2012 and 2020 at a single institution were retrospectively analyzed. Based on preoperative CT scans, patients were categorized as having either porcelain aorta (PA) or non-calcific aorta (NC). Inverse probability of treatment weighting (IPTW) was used to minimize baseline differences, with standardized mean differences (SMD) < 0.1 indicating adequate covariate balance. Logistic regression addressed residual post-IPTW imbalances. Results: A total of 2037 patients with severe symptomatic aortic stenosis were identified, of whom 40 (2%) had PA. Compared to the NC population, PA patients were more likely to be younger (p = 0.002), had a higher prevalence of heart failure symptoms (p = 0.041) and peripheral artery disease (p = 0.006). After adjustment for preoperative characteristics, no significant differences were observed between groups in post-TAVR mortality (p = 0.498), stroke (p = 0.606), or postoperative creatinine levels (p = 0.827). However, PA patients experienced significantly longer in-hospital (p < 0.001) and ICU (p < 0.001) lengths of stay. Conclusions: In this single-center cohort, PA did not appear to confer additional risk of mortality, stroke or renal failure, although it remained associated with longer postoperative in-hospital and ICU lengths of stays. TAVR appears to be a safe and effective method of AVR when significant circumferential atherosclerotic aortic calcification precludes aortic cross-clamping.