title: Predictors of clinical outcome in transfemoral TAVI: circumferential iliofemoral calcifications and manufacturer-derived recommendations.
abstract: OBJECTIVE
  This study aimed to investigate the predictive value of circumferential iliofemoral calcifications and current manufacturer recommendations, which are not evidence-based, in transfemoral (TF) transcatheter aortic valve implantation (TAVI).
  
  
  METHODS
  A patient cohort with a broad range of iliofemoral anatomies undergoing TF TAVI (n=132) were retrospectively divided as "suitable" (n=76, 58%) and "unsuitable" (n=56, 42%) candidates according to current recommendations. Iliofemoral angiography and reconstructed multislice CT (MSCT) images were used for access screening in the majority of patients.
  
  
  RESULTS
  Vessel properties were significantly worse in the "unsuitable group." The sheath-to-iliofemoral artery ratio (SIFAR) and calcium score were 1.35±0.2 and 1.7±0.8 in the unsuitable group, compared to 1.0±0.12 (p<0.0001) and 1.0±0.7 (p=0.0001) in the "suitable" patients. Major vascular complications (MVCs) occurred more frequently in the "unsuitable" group (10.7% vs. 2.6%, p=0.07) and were predicted by SIFAR [OR: 64, 95% CI: 1.4-2971, p=0.03] and circumferential iliofemoral calcifications [OR: 6, 95% CI: 1.2-26, p=0.025]. In the multivariate analysis, circumferential calcifications [HR: 3.6, 95% CI: 1-13.2, p=0.043] but not major vascular complications (MVCs) or manufacturer recommendations were associated with increased mortality.
  
  
  CONCLUSIONS
  According to our results, manufacturer recommendations are safe but overly conservative. Circumferential iliofemoral calcifications may provide independent prognostic information in patients undergoing TAVI.
authors.affiliation: Department of Cardiology, The Heart Hospital University College London Hospitals; London-England. markus.reinthaler@gmx.at.
authors.forename: Markus
authors.initials: M
authors.lastname: Reinthaler
authors.forename: Sunil K
authors.initials: SK
authors.lastname: Aggarwal
authors.forename: Rodney
authors.initials: R
authors.lastname: De Palma
authors.forename: Ulf
authors.initials: U
authors.lastname: Landmesser
authors.forename: Georg
authors.initials: G
authors.lastname: Froehlich
authors.forename: John
authors.initials: J
authors.lastname: Yap
authors.forename: Pascal
authors.initials: P
authors.lastname: Meier
authors.forename: Michael J
authors.initials: MJ
authors.lastname: Mullen
mesh_terms: D000369:Aged, 80 and over; D000792:Angiography; D001024:Aortic Valve Stenosis / Q000000981:diagnostic imaging / Q000401:mortality / Q000601:surgery*; D015331:Cohort Studies; D005260:Female; D005263:Femoral Artery / Q000000981:diagnostic imaging*; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008297:Male; D058729:Peripheral Arterial Disease / Q000000981:diagnostic imaging*; D017410:Practice Guidelines as Topic; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018570:Risk Assessment; D016019:Survival Analysis