Frontiers in Cardiovascular Medicine (Feb 2024)

The impact of concomitant chronic total occlusion on clinical outcomes in patients undergoing transcatheter aortic valve replacement: a large single-center analysis

  • Maximilian Will,
  • Maximilian Will,
  • Maximilian Will,
  • Konstantin Schwarz,
  • Konstantin Schwarz,
  • Thomas Weiss,
  • Thomas Weiss,
  • Gregor Leibundgut,
  • Elisabeth Schmidt,
  • Elisabeth Schmidt,
  • Paul Vock,
  • Paul Vock,
  • Roya Mousavi,
  • Roya Mousavi,
  • Josip A. Borovac,
  • Chun Shing Kwok,
  • Chun Shing Kwok,
  • Uta C. Hoppe,
  • Julia Mascherbauer,
  • Julia Mascherbauer,
  • Gudrun Lamm,
  • Gudrun Lamm

DOI
https://doi.org/10.3389/fcvm.2024.1338253
Journal volume & issue
Vol. 11

Abstract

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BackgroundCoronary artery disease (CAD) is a common finding in patients with severe aortic stenosis undergoing transcatheter aortic valve replacement (TAVR). However, the impact on prognosis of chronic total occlusions (CTOs), a drastic expression of CAD, remains unclear.Methods and resultsWe retrospectively reviewed 1,487 consecutive TAVR cases performed at a single tertiary care medical center. Pre-TAVR angiograms were analyzed for the presence of a CTO. At the time of TAVR, 11.2% (n = 167) patients had a CTO. There was no significant association between the presence of a CTO and in-hospital or 30-day mortality. There was also no difference in long-term survival. LV ejection fraction and mean aortic gradients were lower in the CTO group.ConclusionsOur analysis suggests that concomitant CTO lesions in patients undergoing TAVR differ in their risk profile and clinical findings to patients without CTO. CTO lesion per se were not associated with increased mortality, nevertheless CTOs which supply non-viable myocardium in TAVR population were associated with increased risk of death. Additional research is needed to evaluate the prognostic significance of CTO lesions in TAVR patients.

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