The Iliofemoral tortuosity score predicts access and bleeding complications during transfemoral transcatheter aortic valve replacement: Data from the VIenna Cardio Thoracic aOrtic valve registrY (VICTORY)

Mach, Markus; Poschner, Thomas; Hasan, Waseem; Szalkiewicz, Philipp; Andreas, Martin; Winkler, Bernhard; Geisler, Stephanie; Geisler, Daniela; Rudziński, Paweł; Watzal, Victoria; Strouhal, Andreas; Adlbrecht, Christopher; Delle‐Karth, Georg; Grabenwöger, Martin

doi:10.1111/eci.13491

Cited by 21 publications

(24 citation statements)

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“…The goal of improving the evaluation of patients with indication to TAVI based on pre-procedural CT is meaningful and worthy of pursue. Indeed, other researchers have attempted at capitalizing the diagnostic yield of CT using more readily applicable and sanctionable scores 21 , 29 , 40 , 41 . For instance, the ilio-femoral tortuosity (IFT) score has been recently proposed by Mach et al, and proved to predict a composite of bleeding or access complications 21 .…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, other researchers have attempted at capitalizing the diagnostic yield of CT using more readily applicable and sanctionable scores 21 , 29 , 40 , 41 . For instance, the ilio-femoral tortuosity (IFT) score has been recently proposed by Mach et al, and proved to predict a composite of bleeding or access complications 21 . Notably, the TAVI-CT score should not be viewed as an alternative to established operative or prognostic scores, such as the EuroSCORE, the STS score, or, as recently suggested, the CHA 2 DS 2 -VASC score, the HAS-BLED score, or the combined CHADS-BLED score, as well as more novel modeling approaches 20 , 42 – 44 .…”

Section: Discussionmentioning

confidence: 99%

“…Despite many scores suitable for overall risk prediction in patients with severe aortic stenosis and/or those undergoing TAVI 20 , there is limited guidance on how to synthesize the vast number of measurements generated with CT in patients planned for TAVI 21 – 23 . Building upon extensive experience, thorough review of the literature, and consensus between high volume operators, we generated pre hoc a scoring system, named TAVI-CT score, capable of summarizing poignantly the main findings stemming from a comprehensive CT test for TAVI planning, applying it consistently for several months.…”

Section: Introductionmentioning

confidence: 99%

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TAVI-CT score to evaluate the anatomic risk in patients undergoing transcatheter aortic valve implantation

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Ferraro³

et al. 2022

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Transcatheter aortic valve implantation (TAVI) requires thorough preprocedural planning with non-invasive imaging, including computed tomography (CT). The plethora of details obtained with thoraco-abdominal CT represents a challenge for accurate and synthetic decision-making. We devised and tested a comprehensive score suitable to summarize CT exams when planning TAVI. An original comprehensive scoring system (TAVI-CT score) was devised, including details on cardiac, aortic, iliac and femoral artery features. The score was applied to a prospectively collected series of patients undergoing TAVI at our institution, driving decision making on access and prosthesis choice. Different TAVI-CT score groups were compared in terms of procedural success, acute complications, and early clinical outcomes. We included a total of 200 undergoing TAVI between February 2020 and May 2021, with 74 (37.0%) having a low (0–2) TAVI-CT score, 50 (25.0%) having a moderate (3) TAVI-CT score, and 76 (38.0%) having a high (≥ 4) TAVI-CT score. Male gender was the only non-CT variable significantly associated with the TAVI-CT score (p = 0.001). As expected, access choice differed significantly across TAVI-CT scores (p = 0.009), as was device choice, with Portico more favored and Allegra less favored in the highest TAVI-CT score group (p = 0.036). Acute outcomes were similar in the 3 groups, including device and procedural success rates (respectively p = 0.717 and p = 1). One-month follow-up showed similar rates of death, myocardial infarction, stroke, and bleeding, as well as of a composite safety endpoint (all p > 0.05). However, vascular complications were significantly more common in the highest TAVI-CT score group (p = 0.041). The TAVI-CT score is a simple scoring system that could be routinely applied to CT imaging for TAVI planning, if the present hypothesis-generating findings are confirmed in larger prospective studies.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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TAVI-CT score to evaluate the anatomic risk in patients undergoing transcatheter aortic valve implantation

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Morello

Ferraro³

et al. 2022

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“…The major indications for a TA approach are primarily the inability to perform the valve replacement through a TF approach due to small vessel size or their prominent tortuosity or calcification, a history of previous vascular interventions in the aorta, the iliac or femoral arteries, or a pronounced obesity with deep vessels and, thus, a high risk of vascular complications [ 21 , 22 , 23 , 24 , 25 , 26 ]. In contrast, the list of contraindications for a TA access procedure is rather short and mostly revolves around a reduced ejection fraction or thrombotic material in the apex area [ 21 , 22 , 23 ].…”

Section: Discussionmentioning

confidence: 99%

Identifying Patients without a Survival Benefit following Transfemoral and Transapical Transcatheter Aortic Valve Replacement

Geisler

Rudziński

Hasan

et al. 2021

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Transcatheter aortic valve replacement (TAVR) offers a novel treatment option for patients with severe symptomatic aortic valve stenosis, particularly for patients who are unsuitable candidates for surgical intervention. However, high therapeutical costs, socio-economic considerations, and numerous comorbidities make it necessary to target and allocate available resources efficiently. In the present study, we aimed to identify risk factors associated with futile treatment following transfemoral (TF) and transapical (TA) TAVR. Five hundred and thirty-two consecutive patients (82 ± 9 years, female 63%) who underwent TAVR between June 2009 and December 2016 at the Vienna Heart Center Hietzing were retrospectively analyzed to identify predictors of futility, defined as all-cause mortality at one year following the procedure for the overall patient cohort, as well as the TF and TA cohort. Out of 532 patients, 91 (17%) did not survive the first year after TAVR. A multivariate logistic model identified cerebrovascular disease, home oxygen dependency, wheelchair dependency, periinterventional myocardial infarction, and postinterventional renal replacement therapy as the factors independently associated with an increased one-year mortality. Our findings underscore the significance of a precise preinterventional evaluation, as well as illustrating the subtle differences in baseline characteristics in the TF and TA cohort and their impact on one-year mortality.

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“…8 , 9 , 10 , 11 , 12 Interestingly, the role of iliofemoral tortuosity and the amount of vascular calcification remained, until this year, unexplored. 10 , 11 , 12 , 13 Therefore, we designed a study to prove that vascular calcifications and arterial tortuosity are relevant predictors of vascular and bleeding complications following TF TAVI and plug-based access-site closure.…”

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Iliofemoral Tortuosity Increases the Risk of Access-Site-Related Complications After Aortic Valve Implantation and Plug-Based Access-Site Closure

et al. 2022

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The Iliofemoral tortuosity score predicts access and bleeding complications during transfemoral transcatheter aortic valve replacement: Data from the VIenna Cardio Thoracic aOrtic valve registrY (VICTORY)

Abstract: This is an open access article under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non-commercial and no modifications or adaptations are made.

Cited by 21 publications

References 25 publications

TAVI-CT score to evaluate the anatomic risk in patients undergoing transcatheter aortic valve implantation

TAVI-CT score to evaluate the anatomic risk in patients undergoing transcatheter aortic valve implantation

Identifying Patients without a Survival Benefit following Transfemoral and Transapical Transcatheter Aortic Valve Replacement

Iliofemoral Tortuosity Increases the Risk of Access-Site-Related Complications After Aortic Valve Implantation and Plug-Based Access-Site Closure

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