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In-hospital Outcomes Of Tavr In Patients With Porcelain Aorta
Mohiuddin Cheema, Sarfaraz Memon, Raymond Mckay, Jawad Haider, Robert Hagberg, MD, Sabet Hashim, MD.
Hartford Hospital, Hartford, CT, USA.

OBJECTIVE:
While current American and European guidelines on valvular heart diseaserecommend transcatheter aortic valve replacement (TAVR) rather than surgical aortic valve replacement in patients diagnosed with severe aortic stenosis in the setting of a porcelain aorta (PAo), prior studies have reported contrasting results with respect to TAVR clinical outcomes. METHODS:
From a total cohort of 2,472 TAVR patients treated since 2012, we comparedin-hospital clinical outcomes in 53 PAo patients with 2,410 non-PAo patients.
The diagnosis of porcelain aorta was made by multidisciplinary team of cardiac surgeons, interventional cardiologists, and cardiac imaging specialist following review of multislice computed tomography (MSCT) that identified nearly or completely circumferential calcification of the ascending aorta precluding safe aortic cross clamping or cannulation. RESULTS:
In comparison to the non-PAo cohort, PAo patients were younger (76.6 7.3 vs 81.5 8.3 yrs, p<0.001), more likely male (68% vs 54%, p=0.041), had morecomorbidities including peripheral arterial disease (53% vs 22%, p<0.001), carotid artery disease (49% vs 27%, p= 0.003), and dialysis (8% vs 3%, p = 0.027), and a higher baseline STS Risk Score (14.55 11.74 vs 9.55 7.25, p<0.001).

PAo (n=53)Non-PAo (n=2410)p Value
Mortality1 (1.9%)43 (1.8%)0.962
Ischemic Stroke5 (9.4%)50 (2.1%)0.001
Hemorrhagic Stroke0 (0.0%)6 (0.2%)0.704
Transient Ischemic Attack0 (0.0%)14 (0.6%)0.561
Major Vascular Complication1 (1.9%)45 (1.9%)0.992
Composite Bleeding2 (3.8%)95 (3.9%)0.950
Permanent Pacemaker8 (15.1%)305 (12.7%)0.597

PAo procedures more commonly required non-femoral alternative access (43% vs 13%, p<<0.001) with general anesthesia (62% vs 36%, p=0.001), and more commonly employed self-expanding as opposed to balloon-expandable TAVR valves (45% vs 24%, p=0.001).. CONCLUSIONS:
In comparison to non-PAo patients, PAo patients represent a high- risk TAVR cohort with a more than a four-fold increase in the risk of periprocedural ischemic stroke.


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