https://doi.org/10.1007/s00392-025-02625-4
1Zentralklinik Bad Berka GmbH Klinik für Kardiologie und Internistische Intensivmedizin Bad Berka, Deutschland; 2Helios-Klinikum Erfurt Allgemeine und Interventionelle Kardiologie und Rhythmologie Erfurt, Deutschland; 3Universitätsklinikum Giessen und Marburg GmbH Klinik für Kardiologie, Angiologie und internistische Intensivmedizin Marburg, Deutschland
Background: Current guidelines recommend transcatheter aortic valve implantation (TAVI) for aortic stenosis patients with porcelain aorta (PA). Neurological outcomes of PA patients undergoing TAVI with modern valves requires clarification as most trials examined balloon-expandable valves (BEV) and self-expandable valves in intermediate or high risk patients, but not specifically in PA patients. Our goal was to compare outcomes, including stroke and mortality, in well-matched PA and non-PA patients who received BEV during transfemoral TAVI procedures.
Methods: Consecutive patients treated with TAVI were entered into a registry. For this single-center (Zentralklinik Bad Berka, Germany), retrospective analysis, we only selected patients who received BEV. PA diagnosis was made when non-contrast axial CT images fulfilled Valve Academic Research Consortium 2 criteria for PA. There was 2:1 nearest neighbor matching of non-PA and PA patients. The primary outcome measure was 30-day mortality or stroke within 72 hours. Secondary outcome measures were 30-day mortality, stroke within 72 hours, technical success, and 30-day device success.
Results: After matching PA (n=141) and non-PA (n=282) patients, the primary outcome of mortality at < 30 days or stroke within 72 hours was higher in PA vs non-PA (7.8% vs 2.5%; OR 3.32 (95% CI 1.25-8.85); p=0.019). With regard to secondary outcomes, PA was not associated with mortality at 30 days (4.3% vs 2.1%, OR 2.04. (95% CI 0.65-6.48); p=0.23); however, stroke within 72 hours was significantly higher in PA vs non-PA (3.5% vs 0.4%, OR 10.33 (95% CI 1.17-91.12); p = 0.017). Technical and device success were uninfluenced by PA.
Conclusions: Transfemoral TAVI with BEV in PA patients was associated with a higher risk of the primary combined endpoint of mortality at 30 days or stroke within 72 hours, which was primarily driven by stroke within 72 hours. These findings might influence cerebral embolic protection device use in PA patients.