Journal Article

Long-term Outcomes Following Transcatheter Aortic Valve Replacement in Patients With Severe Aortic Atheroma

Kikuchi, Shinnosuke, Heyberger, Zoe, Loizon, Florian, Leddet, Pierre, Vu, Manh Cuong, Trimaille, Antonin, Marchandot, Benjamin, Matsushita, Kensuke, Zheng, Franck, Jesel, Laurence, Knellwolf, Paul, Hibi, Kiyoshi, De Poli, Fabien, Recht, Dorian, Carmona, Adrien, Truong, Dinh Phi, Granier, Amandine, Morel, Olivier, Koenig, Baudouin, Ohlmann, Patrick, Sun, Julien Tse Sik

2025

Overview

•Severe aortic atheroma was an independent risk factor for 2-year MACCE following TAVR.•Severe aortic atheroma was associated with periprocedural ischemic stroke and CV death (≤30 d), and late stroke (>1 y post-TAVR).•Severe aortic atheroma constitutes a major harmful factor associated with periprocedural events and can affect late stroke post-TAVR. Although aorta atheroma morphology is associated with acute outcomes post-transcatheter aortic valve replacement (TAVR), its association with long-term outcomes post-TAVR remains unknown. This study evaluates the impact of severe aortic atheroma on long-term outcomes following TAVR. We enrolled 977 patients who underwent TAVR between February 2010 and May 2019, with available contrast-enhanced computed tomography data. Severe aortic atheroma was defined as protruding atheroma of ≥3mm thickness with protruding components, ulcerated atheroma with ulcer-like intimal disruption, and atheroma of ≥5mm thickness. The primary endpoint was 2-year major adverse cardiac and cerebrovascular event (MACCE), defined as a composite of cardiovascular death, myocardial infarction, ischemic stroke, and heart failure, events classified as periprocedural (≤30 days), early (30 days to 1 year), and late (>1-year post-TAVR). Patients with severe aortic atheroma (n = 274, 28%) had a higher cumulative incidence of 2-year MACCE than those without (40.6% vs 28.9%, log-rank p = 0.0002), which was attributed to increased risks of ischemic stroke (13.8% vs 6.8%, log-rank p = 0.0012) and cardiovascular death (18.6% vs 10.8%, log-rank p = 0.0009). Severe aortic atheroma was an independent risk factors for 2-year MACCE (adjusted hazard ratio [aHR], 1.49, 95% CI 1.16 to 1.90). In the landmark analysis, severe aortic atheroma was independently associated with periprocedural ischemic stroke and cardiovascular death (aHR, 2.12, 95% CI 1.15 to 3.90 and aHR, 3.29, 95% CI 1.70 to 6.37, respectively), and late ischemic stroke (aHR, 3.71, 95% CI 1.35 to 10.2). Patients with severe aortic atheroma have an increased risk of 2-year MACCE post-TAVR.

• Publisher: Elsevier Inc,Elsevier Limited
• Subject: Aged / Aged, 80 and over / Anticoagulants / Aorta / aortic atheroma / Aortic Diseases - complications / Aortic valve / Aortic Valve Stenosis - complications / Aortic Valve Stenosis - surgery / cardiovascular death / Catheters / Cerebral infarction / Computed tomography / Congestive heart failure / Coronary vessels / Death / Female / Heart valves / Humans / Ischemia / ischemic stroke / Ischemic Stroke - epidemiology / MACCE / Male / Myocardial infarction / Plaque, Atherosclerotic - complications / Plaque, Atherosclerotic - diagnostic imaging / Postoperative Complications - epidemiology / Retrospective Studies / Risk Factors / Severity of Illness Index / Stroke / Stroke - epidemiology / Thickness / Time Factors / Transcatheter Aortic Valve Replacement / Transient ischemic attack / Treatment Outcome / Vein & artery diseases