title: Transcatheter aortic valve implantation in patients with "porcelain" aorta (from a Multicenter Real World Registry).
abstract: The presence of severe atherosclerosis of the ascending aorta, and its extreme form the "porcelain" aorta, is associated with a worse clinical outcome in patients undergoing surgical aortic valve replacement. Percutaneous transcatheter aortic valve implantation (TAVI) for severe symptomatic aortic stenosis can overcome this problem: 1,374 TAVI procedures were performed at 27 hospitals in 147 patients (10.7%) with and 1,227 (89.3%) without a porcelain aorta. The mean reported prevalence of a porcelain aorta at the hospitals was 7.8% ± 14.8% (range 0% to 70%). Diabetes mellitus (46.3% vs 33.2%, p = 0.00018), chronic obstructive pulmonary disease (43.5% vs 22.2%, p <0.0001), and peripheral arterial obstructive disease (34.7% vs 20.0%, p <0.0001) were more prevalent in patients with a porcelain aorta. In patients with a porcelain aorta, coronary ischemia occurred more often (2.0% vs 0.1%, p <0.0001), with a tendency toward a greater stroke rate (5.5% vs 2.8%, p = 0.08), greater in-hospital death rate (10.9% vs 8.1%, p = 0.24), and greater death or stroke rate (14.4% vs 10.2%, p = 0.12). On multivariate analysis, the presence of a porcelain aorta was not associated with in-hospital death (odds ratio 1.36, 95% confidence interval 0.72 to 2.55, p = 0.3441) nor in-hospital death or stroke (odds ratio 1.50, 95% confidence interval 0.81 to 2.47, p = 0.2207). In conclusion, in this real-world TAVI registry, a "porcelain" aorta was diagnosed in almost every tenth patient. Although differences were found in its frequency among the participating hospitals, the presence of a porcelain aorta was not associated with in-hospital death or stroke.
authors.affiliation: Abteilung für Kardiologie, Herzzentrum Ludwigshafen, Ludwigshafen, Germany. erzahn@aol.com
authors.forename: Ralf
authors.initials: R
authors.lastname: Zahn
authors.forename: Rudolf
authors.initials: R
authors.lastname: Schiele
authors.forename: Ulrich
authors.initials: U
authors.lastname: Gerckens
authors.forename: Axel
authors.initials: A
authors.lastname: Linke
authors.forename: Horst
authors.initials: H
authors.lastname: Sievert
authors.forename: Philipp
authors.initials: P
authors.lastname: Kahlert
authors.forename: Rainer
authors.initials: R
authors.lastname: Hambrecht
authors.forename: Stefan
authors.initials: S
authors.lastname: Sack
authors.forename: Mohamed
authors.initials: M
authors.lastname: Abdel-Wahab
authors.forename: Ellen
authors.initials: E
authors.lastname: Hoffmann
authors.forename: Jochen
authors.initials: J
authors.lastname: Senges
mesh_terms: D000369:Aged, 80 and over; D001013:Aorta, Thoracic; D001018:Aortic Diseases / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000601:surgery*; D050197:Atherosclerosis / Q000150:complications* / Q000175:diagnosis / Q000601:surgery; D006328:Cardiac Catheterization; D005260:Female; D005500:Follow-Up Studies; D005858:Germany / Q000453:epidemiology; D019918:Heart Valve Prosthesis Implantation / Q000379:methods*; D017052:Hospital Mortality / Q000639:trends; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D016017:Odds Ratio; D011446:Prospective Studies; D012042:Registries; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D012720:Severity of Illness Index; D015996:Survival Rate / Q000639:trends; D016896:Treatment Outcome