Impact of aortic aneurysms in trans-catheter aortic valve replacement: A single center experience

Abstract

BackgroundPatients who undergo trans-catheter aortic valve replacement (TAVR) may have concomitant aortic aneurysms. We sought to clarify the incidence of aortic aneurysms and its impact on clinical outcomes among patients undergoing TAVR.MethodsWe performed a retrospective analysis of patients with severe symptomatic aortic stenosis who underwent TAVR from January 2012 to June 2016. Multi-detector computer tomography (MDCT) was performed on all patients and images were reviewed to identify thoracic and abdominal aortic aneurysms (TAA and AAA). The incidence of vascular complications (VARC-2 definition), and in-hospital and 6-month major adverse cardiac events (MACE) defined as a composite of all-cause mortality, cardiac arrest, myocardial infarction, and stroke were recorded.ResultsAmong 232 patients included in the analysis, 22 patients (9.5%) had aortic aneurysms (11 had AAA, 8 had TAA, and 3 had both). Patients with aortic aneurysms had a higher, albeit statistically insignificant, rate of smoking history (63.6% vs. 42.9%, p = 0.062). Both groups of patient predominantly underwent TAVR via trans-femoral access (72.7% vs. 71.4%, p = 0.90). The incidence of vascular complications was similar between the two groups (9.1% vs. 10.5%, p = 1.0). Patients with aortic aneurysms had a similar in-hospital MACE (4.5% vs. 6.2%, p = 1.0) and 6-month MACE (9.1% vs. 9.0%, p = 1.0) compared to those without aneurysms.ConclusionsIn our patient cohort, 9.5% of patients who underwent TAVR had concomitant aortic aneurysms. Patients with aortic aneurysms had similar incidence of vascular complications as well as in-hospital and 6-month MACE compared to those without.

Aortic aneurysm in patients undergoing transcatheter aortic valve implantation: A prognostic determinant? or just an innocent bystander?

“…Accordingly, did the types of TAVI bioprostheses (balloon-expanding, self-expanding, and mechanically expanding) differ significantly between patients with and without an aortic aneurysm in the present study 3 ? Importantly, particular performance of TAVI specifically by more experienced operators along with the cautious use of more resilient and smaller delivery systems in patients with an aortic aneurysm might have neutralized the potential difference between the groups particularly in terms of periprocedural vascular complications 3 …”

“…Second, as opposed to the conventional belief, the diameter of a given aneurysm might not serve as the sole determinant of its complication risk (rupture, dissection, and so forth), suggesting the particular roles of certain structural factors including the presence of mural thrombus, degrees of local inflammation, and calcification within the aneurysmatic wall 6 as well as the magnitude of wall thickness. Therefore, relatively small aneurysm sizes, and probably, favorable structural features (diminishing vulnerability of aneurysmal sacs) might have precluded excess iatrogenic or long-term spontaneous complications associated with aneurysms in the present study 3 . Importantly, structural characteristics of aneurysmal sacs (on top of aneurysm diameter) should particularly be evaluated through advanced diagnostic modalities such as magnetic resonance imaging, positron emission tomography, and so forth 6 for the prediction of procedural and long-term complication risks (and hence, to implement the most proper therapeutic strategy) in the setting of TAVI.…”

“…However, periprocedural complications as well as long-term mortality among TAVI recipients still remain relatively high largely attributable to the significant baseline comorbidities of these high-risk subjects 1, 2. In their recently published elegant study, 3 Kobayashi et al. have demonstrated the neutral clinical impact of accompanying aortic aneurysms in the setting of TAVI with regard to periprocedural vascular complications along with in-hospital and 6-month adverse cardiovascular events.…”

“…Within this context, certain valve types were previously suggested to be more likely to elicit acute vascular complications including aortic dissection and other life-threatening conditions including late coronary ischemic syndromes etc 4, 5 3 ? Importantly, particular performance of TAVI specifically by more experienced operators along with the cautious use of more resilient and smaller delivery systems in patients with an aortic aneurysm might have neutralized the potential difference between the groups particularly in terms of periprocedural vascular complications 3 …”

Current and Future Aspects of Multimodal Imaging, Diagnostic, and Treatment Strategies in Bicuspid Aortic Valve and Associated Aortopathies

“…Interestingly, case reports have demonstrated successful transapical TAVR in combination with thoracic endovascular aortic repair in a patient with 8.0 cm ascending aneurysm and 4.2 cm aortic arch aneurym as a possible approach in high-risk inoperable patients. Furthermore, it has been reported that there was no increase of the ascending aortic aneurym after TAVR in BAV anatomy [22].…”