Prognostic impact of iliofemoral access-site calcification volume on outcomes after transcatheter aortic valve implantation.

BACKGROUND

Transcatheter aortic valve implantation (TAVI) is increasingly performed in patients at low and intermediate risk, emphasizing the need for accurate long-term risk stratification. Although iliofemoral calcification influences procedural planning, its prognostic relevance beyond peri-procedural complications remains uncertain.

OBJECTIVES

To evaluate the prognostic value of quantitatively assessed iliofemoral access-site calcification (IASC) for outcomes after TAVI.

METHODS

The study included 1067 patients undergoing TAVI. Pre-procedural computed tomography (CT) was used to quantify IASC-volume along the transfemoral access route. Patients were stratified according to the median IASC-volume, and outcomes were compared using propensity score matching (PSM). The primary endpoint was all-cause mortality at 1, 3, and 5 years. Secondary endpoints included peri-procedural complications at 30 days.

RESULTS

The median IASC-volume was 907 (356-1839) mm3. Patients with high IASC-volume had higher prevalence of vascular comorbidities and increased risk scores. IASC-volume was not associated with vascular or bleeding complications. The overall 1-year mortality was 11.7% and did not differ between patients with low and high IASC-volume (10.5% vs. 12.8%; p = 0.20). In contrast, patients with high IASC-volume experienced significantly higher mortality at 3 years (34.3% vs. 22.3%; p < 0.01) and 5 years (42.2% vs. 28.7%; p < 0.01). These findings remained consistent after PSM. In multivariable analysis, IASC-volume was independently associated with long-term mortality (HR 1.24, 95% CI 1.11-1.38; p < 0.01).

CONCLUSION

CT-derived IASC-volume is associated with mid- and long-term mortality after TAVI, without affecting short-term or procedural outcomes. These findings suggest that IASC-volume reflects systemic disease burden and may provide incremental prognostic information beyond established risk scores.