Cardiovascular Surgery Fellow Mayo Clinic Rochester, Minnesota, United States
Disclosure(s):
Jonathan Afoke, MD FRCS: No financial relationships to disclose
Purpose: Transcatheter aortic valve replacement (TAVR) has revolutionized the paradigm of treatment of aortic valve disease. High computed tomography aortic valve calcium score is a risk factor for cardiovascular complications after TAVR. Our aim is to examine whether high aortic valve calcium score affects outcomes after surgical aortic valve replacement (SAVR). Methods: We retrospectively reviewed the records of 2952 consecutive patients who had SAVR +/- coronary artery bypass grafting (CABG) from January 2017 through December 2022. 2103 patients had pre-operative aortic valve calcium score measured. The cohort was divided into low calcium score and high calcium score (defined as >1300 in females and >2000 in men). Patient and procedure related characteristics were analysed with multivariable binary logistic regression for an association with a composite outcome of operative mortality, post-operative neurological event and post-operative pacemaker implantation. Results: Patient mean age was 79 ± 9 years, male sex was present in 1272 patients (59.8%), 104 (4.9%) had concomitant CABG and STS predicted risk of mortality was 2.3 ± 2.1%. 571 patients had low aortic valve calcium score and 1532 patients had high aortic valve calcium score. Patients with high aortic valve calcium score had a lower rate of diabetes (516 (33.7%) vs. 220 (38.6%, p=0.037) and higher incidence of pre-operative dialysis (36 (2.3%) vs. 5 (0.9%), p=0.03), but there was no significant difference in cardiovascular risk factors.
There were 11 mortalities (2 (0.4%) in low calcium score group vs. 9 (0.6%) in high calcium score group); 24 strokes (10 (1.8%) in low calcium score group vs. 14 (0.9%) in high calcium score group); 5 transient ischaemic attacks (2 (0.7%) in low calcium score group vs. 3 (0.4%) in high calcium score group); 331 pacemaker implantations (68 (12.0%) in low calcium score group vs. 263 (17.2%) in high calcium score group). Multivariate analysis showed that calcium score was not a significant factor in predicting the composite outcome of death, neurological complication of pacemaker when considered alone (univariate p=0.084) or when potential confounders were included (multivariable p=0.990). Conclusion: High calcium score is not associated with an increase in operative mortality, neurological event or pacemaker implantation after SAVR. We suggest in patients with high calcium score where treatment with either TAVR or SAVR is equipoise, that treatment with SAVR may be preferable.
Identify the source of the funding for this research project: No funding was required for this research project.
.jpg "Jonathan Afoke, MD, FRCS (he/him/his) photo")