Evaluation of aortic arch calcification to predict prognosis after transcatheter aortic valve replacement

Few centers routinely report aortic arch calcification (AAC) due to the lack of an easy and effective evaluation method. The association between AAC and the clinical prognosis of patients who undergo transcatheter aortic valve replacement (TAVR) is unclear. We aimed to develop a rapid method to evaluate AAC in patients who underwent TAVR and to further assess their prognosis. We enrolled 464 consecutive patients with aortic stenosis who underwent TAVR. Patients with severe (11.2%), moderate (18.5%), mild (58.2%), and no (12.1%) AAC had an estimated 3-year all-cause mortality incidence of 39.6%, 20.8%, 13.4%, and 6.7% (log rank p < 0.001), respectively. Patients with severe AAC had a significantly higher incidence of both cardiovascular (log rank p = 0.002) and non-cardiovascular mortality (log rank p = 0.009), whereas patients with moderate AAC had a higher incidence of only non-cardiovascular mortality (p = 0.003) compared with patients with no/mild AAC. Moderate/severe AAC was an independent predictor of 3-year all-cause mortality in univariate (hazard ratio [HR]: 2.39, 95% confidence interval [CI]: 1.41-4.03; p = 0.001) and multivariate COX regression analyses (HR: 1.78, 95%CI: 1.04-3.06; p = 0.037). Our rapid semi-quantitative method to evaluate AAC is highly reproducible and can be used to assess AAC in patients who undergo TAVR.